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iM  A 


4 


<•{ 


AW 


^Eibrar^ 


N  THE  CUSTODY  OF  THE 

BOSTON     PUBLIC   LIBRARY. 


SHELF    N° 

Adam  5 

I/30.I2L    *A 


FN909   5.12,37  :    150 


MEDICAL  INQUIRIES 


AND 


OBSERVATIONS. 


BY  BENJAMIN  RUSH,  M.  D. 

PROFESSOR   OF    THE    INSTITUTES    AND    PRACTICE    OF    MEDICINE, 

AND    OF    CLINICAL    PRACTICE,    IN    THE    UNIVERSITY 

OF    PENNSYLVANIA. 


IN  FOUR  VOLUMES. 
VOL.  IV. 


THE  SECOND  EDITION, 

REVISED    AND    ENLARGED    BY    THE    AUTHOR. 


PHILADELPHIA, 

PUBLISHED  BY  J.  CONRAD  &  CO.  CHESNUT-STREET,  PHILADELPHIA; 
M.  &  J.  CONRAD  &  CO.  BALTIMORE  ;  RAPIN,  CONRAD,  &  CO.  WASH- 
INGTON J  SOMERVELL  &  CONRAD,  PETERSBURG;  AND  BONSAL, 
CONRAD,  &  CO.  NORFOLK. 

PRINTED  BY  T.  tS*  G.  PALMER,  116,  HIGH-STREET, 

1805, 


CONTENTS  OF  VOLUME  IV. 


page 
AN  account  of  the  bilious  yellow  fever,  as  it  appeared 

in  Philadelphia  in  1797  1 

An  account  of  the  bilious  yellow  fever,  as  it  appeared 

in  Philadelphia  in  1798  63 

An  account  of  the  bilious  yellow  fever,  as  it  appeared 

in  Philadelphia  in  1799  89 

An  account  of  sporadic  cases  of  yellow  fever,  as  they 

appeared  in  Philadelphia  in  1800    .  101 

An  account  of  sporadic  cases  of  yellow  fever,  as  they 

appeared  in  Philadelphia  in  1801  109 

fin  account  of  the  measles,  as  they  appeared  in  Phi- 
ladelphia in  1 801  115 
An  account  of  the  yellow  fever,  as  it  appeared  in  1802  121 
An  account  of  the  yelloxv  fever,  as  it  appeared  in  1803   131 
An  account  of  sporadic  cases  of  yellow  fever,  as  they    - 

appeared  in  1804  145 

An  account  of  the  yellow  fever,  as  it  appeared  in  1805  151 
An  inquiry  into  the  various  sources  of  the  usual  forms 
of  the  summer  and  autumnal  disease  in  the  United 
States,  and  the  means  of  preventing  them  161 


IV 

page 

Tacts,  intended  to  prove  the  yellow  fever  not  to  be 

contagious  221 

Defence  of  blood-letting,  as  a  remedy  in  certain  dis- 
eases 273 
An  inquiry  into  the  comparative  states  of  medicine  in 
Philadelphia,  between  the  years  1760  and  1766, 
and  1805  363 


AN  ACCOUNT 


OF    THE 


BILIOUS  REMITTING  AND  INTERMITTING 

TEL  LOW  FEVER, 

AS    IT 

-APPEARED   IN   PHILADELPHIA, 
in   1797. 


VOL.  IV. 


AN  ACCOUNT,  &c. 


THE  winter  of  1797  was  in  general  healthy. 
During  the  spring,  which  was  cold  and  wet,  no 
diseases  of  any  consequence  occurred.  The  spring 
vegetables  were  late  in  coming  to  maturity,  and 
there  were  every  where  in  the  neighbourhood  of 
Philadelphia  scanty  crops  of  hay.  In  June  and 
July  there  fell  but  little  rain.  Dysenteries,  chole- 
ras, scarlatina,  and  mumps,  appeared  in  the  sub- 
urbs in  the  latter  month.  On  the  8th  of  July  I 
visited  Mr.  Frisk,  and  on  the  25th  of  the  same 
month  I  visited  Mr.  Charles  Burrel  in  the  yellow 
fever,  in  consultation  with  Dr.  Physick.  They 
both  recovered  by  the  use  of  plentiful  depleting 
remedies. 

The  weather  from  the  2d  to  the  9th  of  August 
was  rainy.     On  the  1st  of  this  month  I  was  called 


4  AN    ACCOUNT    OF    THE 

to  visit  Mr.  Nathaniel  Lewis,  in  a  malignant  bilious 
fever.  On  the  3d  I  visited  Mr.  Elisha  Hall,  with 
the  same  disease.  He  had  been  ill  several  days  be- 
fore I  saw  him .  Both  these  gentlemen  died  on  the 
6th  of  the  month.  They  were  both  very  yellow 
after  death.  Mr.  Hail  had  a  black  vomiting  om 
the  day  he  died. 

The  news  of  the  death  of  these  two  citizens, 
with  unequivocal  symptoms  of  yellow  fever,  excit- 
ed a  general  alarm  in  the  city.     Attempts  were 
made  to  trace  it  to  importation,  but  a  little  investi- 
gation soon  proved  that  it  was  derived  from  the 
foul  air  of  a  ship  which  had  just  arrived  from  Mar- 
seilles, and  which  discharged  her  cargo  at  Pine- 
street  wharf,  near  the  stores  occupied  by  Mr.  Lewis 
and  Mr.   Hall.      Many  other  persons  about  the 
same  time  wrere  affected  with  the  fever  from  the 
same  cause,   in  Water  and  Penn-streets.     About 
the  middle  of  the  month,  a  ship  from  Hamburgh 
communicated  the  disease,  by  means  of  her  foul  air, 
to  the  village  of  Kensington.     It  prevailed,  more- 
over, in  many  instances  in  the  suburbs,  and  in 
Kensington,  from  putrid  exhalations  from  gutters 
and  marshy  grounds,  at  a  distance  from  the  Dela- 
ware, and  from  the  foul  ships  which  have  been 
mentioned.     Proofs  of  the  truth  of  each  of  these 
assertions  were  afterwards  laid  before  the  public. 


BILIOUS    YELLOW    FEVER    OF    1797.  5 

The  disease  was  confined  chiefly  to  the  district 
of  Southwark  and  the  village  of  Kensington,  for 
several  weeks.  In  September  and  October,  many- 
cases  occurred  in  the  city,  but  most  of  them  were 
easily  traced  to  the  above  sources. 

The  following  account  of  the  weather,  during 
the  months  of  August,  September,  and  October 
was  obtained  from  Mr.  Thomas  Pryor.  It  is  diffe- 
rent from  the  weather  in  1793.  It  is  of  conse- 
quence to  attend  to  this  fact,  inasmuch  as  it  shows 
that  an  inflammatory  constitution  of  the  atmosphere 
can  exist  under  different  circumstances  of  the  wea- 
ther. It  likewise  accounts  for  the  variety  in  the 
symptoms  of  the  fever  in  different  years  and  coun- 
tries. Such  is  the  influence  of  season  and  climate 
upon  the  symptoms  of  this  fever,  that  it  led  Dr. 
M'Kitterick  to  suppose  that  the  yellow  fever  of 
Charleston,  so  accurately  described  by  Dr.  Lining, 
in  the  second  volume  of  the  Physical  and  Literary 
Essays  of  Edinburgh,  was  a  different  disease  from 
the  yellow  fever  of  the  West- Indies*. 

*  De  Febre  Indiae-Occidentalis  Maligna  Flava,  p.  12. 


6 


AN    ACCOUNT    OF    THE 


METEOROLOGICAL  OBSERVATIONS, 

MADE  IJV  PHILADELPHIA. 

AUGUST,  1797. 


1 

2 


Ther.  ,Ba>*om. 


6 

7 

8 
9 

10 
11 
12 


73 
72 

72 

72 
74 


.'5 

76 

78 

78 
79 


1 

14 
15 
10 
17 
18 

19 

20 
21 
22 


73 
70 

72 
72 
69 
70 
71 


70 
56 
60 

60 
68 

72 

70 
74 
68 


30 
30 


30 
29 


76 
76 

76 
76 
73 
74 
74 

75 
74 
60 
64 
65 
75 

78 

77 
76 
76 


Winds  and  Weather. 


30      6 


84 


30 
30 

29 
29 
30 
30 
30 

29 
29 
30 
30 
30 
30 


86 

4 

95 
86 
16 
25 
5 

87 

9 

15 

24 
24 

4 


S.  E«  E.     kain  in  the  forenoon  and  afternoon. 

N.  E.  by  E.     Cloudy,  Tvith  rain  in  the  after 
noon  and  night.     Wind  E.  by  N. 

E.  -|  N".    Rain  in  the  morning,  and  all  day  and 
night. 

E.     Rained  hard  all  day  and  at  night. 

Wind  light,  S.  W.     Cloudy.     Rain  this  mor 
ning.    The  air  extremely  damp  ;  wind  shift- 
ed to  N.  W.     This  evening  heavy  showers, 
with  thunder. 

YV.  N.  W.     Cloudy. 

N.  W.     Close  day.     Rain  in  the  evening  and 
all  night.     Wind  to  E. 

iL.     Rain  this  morning. 

S.  W.     Cloudy  morning. 

N.  W.     Clear. 

N.  W.     Clear.     Rain  all  night 

S.  W.    Cloudy.    Rain  in  the  morning.  Cloudy 
all  day.     Rain  at  night. 

S.  W.     Cloudy.     Rain  all  day 
Clear  fine  morning 
Clear  fine  morniug 


29     7 


29 
29 


N.  W. 
N.  W. 
N.  W. 
N.  W. 
S.  W. 


Clear  fine  morning. 


Air  damp. 

Cloudy.    Rain,  with  thunder  at  night : 
a  fine  shower. 
N.  W.     Clear.     Cloudy  in  the  evening,  with 

thunder. 
W.  N.  W.     Fine  clear  morning. 
X.  W.     Clear  to  E. 

E.    Small  shower  this  morning.    Hard  shower 
at  11,  A.  M.     Wind  N.  E. 


BILIOUS    YELLOW    FEVER    OF    1797. 


AUGUST,  1797. 


D. 

23 

Ther. 

Barom. 

Winds  and  Weather. 

71 

76 

29 

92 

E.     Cloudy.     At  noon  calm. 

24 

71 

75 

29 

95 

Calm  morning  and  clear. 

25 

70 

75 

30 

5 

N.  E.     Clear.     Rain  in  the   afternoon, 
thunder. 

with 

26 

70 

75 

30 

5 

S.  E.     Rain  in  the  morning.     Rained  hard  in 

the  night,  with  thunder,  N.  W. 

27 

68 

76 

29 

9 

N.  W.     Fine  clear  morning. 

28 

64 

75 

29 

96 

N.  W.     Clear. 

■ 

2  j 

59 

70 

30 

0 

E.     Clear. 

30 

70 

76 

30 

1 

E.  by  S.     Rain  in  the  morning. 

68 

74 

30 

14 

S.  E.     Cloudy.     Damp  air  and  sultry. 

1 

SEPTEMBER,  1797. 


D 

Ther.  jBarc 

)m. 
6 

Winds  and  Weather. 

1 

73\80 

30 

S.   W.     Cloudy.     Damp  air.      Rain   in   the 

morning. 

2 

79 

80 

29 

9 

N.  W.  Clear.  Cloudy  in  the  evening,  with 
lightning  to  the  southward. 

3 

68 

74 

30 

0 

N.  by  W.  Cloudy.  Clear  in  the  afternoon 
and  night. 

4 

66 

74 

30 

7 

W.  N.  W.     Clear  fine  morning. 

5 

58 

73 

30 

1 

N.  W.     Clear.     Cloudy  in  the  evening. 

6 

58 

72 

30 

13 

Fresh  at  E.     Clear.     Rain  in  the  evening. 

7 

56 

76 

30 

28 

E.     Clear.     Cloudy  in  the  evening. 

8 

54 

65 

30 

1 

N.  E.  Clear  and  cool  morning.  Flying  clouds 
at  noon. 

u 

56 

65 

30 

1 

E.  N.  E.     Clear. 

10 

58 

63 

30 

26 

N.  E.     Clear  fine  morning.     Wind  fresh  at 

N.  E.  all  day. 

11 

53 

64 

30 

13 

N.  to  E.  with  flying  clouds. 

12 

51 

62 

130 

6 

W.  N.  W.     Clear  cool  morning. 

AN    ACCOUNT    OF    THE 


SEPTEMBER,  1797. 


D. 


13 
14 

15 


16 
17 

18 

19 
20 

21 


Ther.  .Barom 


56 
64 
66 


62 
56 
58 

55 

47 

46 


22  56 
23^56 

24  52 

25  56 
2658 

274b 
28,48 
29:54 
30  60 


67;30 
70^29 
73  29 


70 
67 
63 

63 
63 

60 

65 
66 
66 

68 
68 
63 
63 
63 
65 


29 
30 
2Q 
29 
29 
30 


30 
30 
29 
29 
29 
29 
30 
30 
30 
30 


3 
98 
85 

95 
0 
88 
62 
75 
8 


Winds  and  Weather. 


30     0 


4 

0 

9 

78 

37 

95 

2 

2 

15 

26 


S.  W.     Cloudy.     Clear  in  the  afternoon. 

S.  W.     Clear. 

S.  W.     Rain  in  the  morning.     Cloudy  in  the 

afternoon. 
N.  W.     Clear. 
N.  W.     Clear. 
E.     Cloudy.      Rained  all  day,  and  thunder. 

Rained  very  heavy  at  night. 
W.  N.  W.     Clear  fine  morning. 
W.  N.  W.     Clear  fine  morning.     New  moon 

at  9  50  morning. 
NT.  E.      Clear  fine  morning ;  to  S.  E.  in  the 

evening.     Cloudy  at  night. 
N.  W.    Rain  in  the  morning.     Rain  at  night 
N.  N.  E.     Cloudy. 
E.  by  S.      Clear  fine   morning.      Cloudy   at 

night. 
W.  N.  W.    Clear  fine  morning ;  clear  all  day. 
E.     In  the  morning  flying  clouds. 
N.  W.     Clear  fine  morning;  clear  all  day. 
W.  N.  W.   Clear  fine  morning ;  clear  all  day. 
E.     Clear  fine  morning. 
E.     Fresh.     Cloudy  morning.     Rain   in  the 

night. ______„ 


BILIOUS    YELLOW    FEVER    OF    1797. 


OCTOBER,  1797. 


b.lTher. 

Barom. 

Winds  and  Weather. 

1 

5;, 

6j 

30 

16 

N.  E.  Rain  this  morning,  and  great,  part  of 
the  day. 

9 

55 

66 

30 

0 

N.  W.     Clear. 

3 

60 

70 

29 

9 

S.  E.     Clear.     Air  damp. 

4 

60 

70 

29 

5 

W.  N.  W.     Rain  this  morning. 

- 

46 

6(j 

50 

0 

W.  N.  W .  to  S.  by  W.  in  the  evening.  Clear 
all  day.     White  frost  this  morning. 

6 

5  3 

65 

30 

0 

b.  W.     Clear  fine  morning*     VV  hite  host. 

7 

■  '. 

76 

30 

0 

S*  VV.     Cloudy.     Ram  in  the  night. 

56 

70 

30 

29 

5.  Cloudy  this  morning ;  air  ciamp.  Wind 
shifted  to  W  .  N.  VV .     Blows  fresh. 

o 

50 

60 

29 

85 

W.  N.  Vv  .  Clear  morning,  i' resb  at  N.  W. 
in  the  evening. 

10 

40 

58 

30 

1 

W.  N.  W7.     Clear.     Frost  this  morning. 

1  1 

3& 

.■6 

oO 

2 

W.  N.  W.     Cloudy. 

K 

34 

-  cs 
06 

30 

38 

W.  N.  VV.     Clear.     Ice  this  morning. 

15 

•  5 

5o 

30 

5 

N".     Clear  fine  morning.     Ice  tms  morning. 

14 

40 

60 

30 

28 

N.  E.     Cloudy. 

\i 

50 

65 

30 

16 

VV.  N.  W.     Clear. 

10 

36 

56 

30 

2 

VV.  N.  W.     Clear  fine  morning. 

17 

37 

56 

30 

18 

VV.  N.  W.     Clear  fine  morning. 

lb 

47 

60 

29 

86 

VV.  N.  W.     Clear  fine  weather. 

19 

48 

60 

30 

6 

N.  W.     Clear  fine  clay. 

'JO 

42 

55 

30 

8 

N.  E.  Cioudy.  Rain  in  the  afternoon  and 
night.     Blows  fresh  at  N.  E. 

21 

42 

50 

29 

92 

N.  E.  Blows  fresh  (with  a  little  rain).  Thun- 
der in  the  night,  with  rain. 

22 

44 

56 

29 

57 

N.  W.     Rain  in  the  morning. 

25 

44 

56 

29 

95 

:■>.  VV.     Clear  fine  morning. 

24 

42 

54 

30 

5 

N.  E.     Cioudy.     A  great  deal  of  rain  in  the 

night. 

25 

40 

52 

50 

15 

N.  E.     Clear  fine  morning. 

26 

36 

48 

50 

29 

vV.  N.  VV.     Clear. 

27 

34 

46 

30 

23 

i'resh  at  S.  W.     Clear. 

28 

40 

52 

29 

95 

vV.  N.  W\     Cloudy. 

29 

34 

46 

29 

82 

W.     Cloudy. 

30 

32 

42 

29 

93 

N.  W.     Clear.     Hard  frost  this  morning. 

51 

38 

48 

30 

18 

W.  S.  VV.  Cloudy  part  of  this  day  ;  clear  the 
remainder. 

I 

VOL.     IV. 


B 


10  AN    ACCOUNT    OF    THE 

In  addition  to  die  register  of  the  weather  it  may 
not  be  improper  to  add,  that  moschetoes  were  more 
numerous  during  the  prevalence  oi  the  fever  than 
in  1793.  An  unusual  number  of  ants  and  cock- 
roaches  were  likewise  observed ;  and  it  wras  said 
that  the  martins  and  swallows  disappeared,  for  a 
while,  from  the  city  and  its  neighbourhood. 

A  disease  prevailed  among  the  cats  some  weeks 
before  the  yellow  fever  appeared  in  the  city.  It 
excited  a  belief  in  an  unwholesome  state  of  the  at- 
mosphere, and  apprehensions  of  a  sickly  fall.  It 
generally  proved  fatal  to  them. 

After  the  first  week  in  September  there  were  no 
diseases  to  be  seen  but  yellow  fever.  In  that  part 
of  the  town  which  is  between  Walnut  and  Vine- 
streets  it  was  uncommonly  healthy.  A  similar  re- 
treat of  inferior  diseases  has  been  observed  to  take 
place  during  the  prevalence  of  the  plague  in  Lon- 
don, Holland,  and  Germany,  according  to  the  his- 
tories of  that  disease  by  Sydenham,  Diemerbroek, 
Sennertus,  and  Hildanus.  It  appears,  from  the 
register  of  the  weather,  that  it  rained  during  the 
greatest  part  of  the  day  on  the  1st  of  October. 
The  effects  of  this  rain  upon  the  disease  shall  be 
mentioned  hereafter.  On  the  10th  the  weather 
became  cool,  and  on  the  nights  of  the  12th  and 


BILIOUS    YELLOW    FEVER    OF    1797.  11 

13th  of  the  month  there  was  a  frost  accompanied 
with  ice,  which  appeared  to  give  a  sudden  and  com- 
plete check  to  the  disease. 

The  reader  will  probably  expect  an  account  of 
the  effects  of  this  distressing  epidemic  upon  the 
public  mind.  The  terror  of  the  citizens  for  a  while 
was  very  great.  Rumours  of  an  opposite  and  con- 
tradictory nature  of  the  increase  and  mortality  of 
the  fever  were  in  constant  circulation.  A  stoppage 
was  put  to  business,  and  it  was  computed  that 
about  two  thirds  of  the  inhabitants  left  the  city. 

The  legislature  of  the  state  early  passed  a  law, 
granting  10,000  dollars  for  the  relief  of  the  suffer- 
ers by  the  fever.  The  citizens  in  and  out  of  town, 
as  also  many  of  the  citizens  of  our  sister  states, 
contributed  more  than  that  sum  for  the  same  cha- 
ritable purpose.  This  money  was  issued  by  a  com- 
mittee appointed  by  the  governor  of  the  state.  An 
hospital  for  the  reception  of  the  poor  was  establish- 
ed on  the  east  side  of  the  river  Schuylkill,  and 
amply  provided  with  every-  thing  necessary  for  the 
accommodation  of  the  sick.  Tents  were  likewise 
pitched  on  the  east  side  of  Schuylkill;,  to  which  ill 
those  people  were  invited  who  were  exposed  to 
dagger  oL  taking  the  disease,   and   who  had   : 


12  AN    ACCOUNT    OF    THE 

means  to  provide  a  more  comfortable  retreat  for 

themselves  in  the  country. 

• 

I  am  sorry  to  add  that  the  moral  effects  of  the 
fever  upon  the  minds  of  our  citizens  were  confined 
chiefly  to  these  acts  of  benevolence.  Many  of  the 
publications  in  the  newspapers  upon  its  existence, 
mode  of  cure,  and  origin  partook  of  a  virulent 
spirit,  which  ill  accorded  with  the  distresses  of  the 
city.  It  was  a  cause  of  lamentation  likewise  to 
many  serious  people,  that  the  citizens  in  general 
were  less  disposed,  than  in  1793,  to  acknowledge 
the  agency  of  a  divine  hand  in  their  afflictions.  In 
some  a  levity  of  mind  appeared  upon  this  solemn 
occasion.  A  worthy  bookseller  gave  me  a  melan- 
choly proof  of  this  assertion,  by  informing  me, 
that  he  had  never  been  asked  for  playing  cards  so 
often,  in  the  same  time,  as  he  had  been  during  the 
prevalence  of  the  fever. 

Philadelphia  was  not  the  only  place  in  the  United 
States  which  suffered  by  the  yellow  fever.  It  pre- 
vailed, at  the  same  time,  at  Providence,  in  Phode- 
Island,  at  Norfolk,  in  Virginia,  at  Baltimore,  and  in 
many  of  the  country  towns  of  New- England,  New> 
Jersey,  and  Pennsylvania, 


BILIOUS    YELLOW    FEVER    OF    1797.  13 

The  influenza  followed  the  yellow  fever,  as  it  did 
in  the  year  1793.  It  made  its  appearance  in  the 
latter  end  of  October,  and  affected  chiefly  those 
citizens  who  had  been  out  of  town. 

The  predisposing  causes  of  the  yellow  fever,  in 
the  year  1797,  were  the  same  as  in  the  year  1793. 
Strangers  were  as  usual  most  subject  to  it.  The 
heat  of  the  body  in  such  persons,  in  the  West- In- 
dies, has  been  found  to  be  between  three  and  four 
degrees  above  that  of  the  temperature  of  the  na- 
tives. This  fact  is  taken  notice  of  by  Dr.  M'Kit- 
terick,  and  to  this  he  ascribes,  in  part,  the  predis- 
position of  new  comers  to  the  yellow  fever. 

In  addition  to  the  common  exciting  causes  of 
this  disease  formerly  enumerated,  I  have  only  to 
add,  that  it  was  induced  in  one  of  my  patients  by 
smoking  a  segar.  He  had  not  been  accustomed  to 
the  use  of  tobacco. 

I  saw  no  new  premonitory  symptoms  of  this  fever 
except  a  tooth-ach.  It  occurred  in  Dr.  Physick, 
Dr.  Caldwell,  and  in  my  pupil,  Mr.  Bellenger.  In 
Miss  Elliot  there  was  such  a  soreness  in  her  teeth, 
that  she  could  hardly  close  her  mouth  on  the  day 
in  which  she  was  attacked  by  the  fever.     Neither 


14  AN"    ACCOUNT    OF    THE 

of  these  persons  had  taken  mercury  to  obviate  the 
disease. 

I  shall  now  deliver  a  short  account  of  the  symp- 
toms of  the  yellow  fever,  as  they  appeared  in  seve- 
ral of  the  different  systems  of  the  body. 

I.  There  was  but  little  difference  in  the  state  of 
the  pulse  in  this  epidemic  from  what  has  been  re- 
corded in  the  fevers  of  1793  and  1794.  I  per- 
ceived a  pulse,  in  several  cases,  which  felt  like  a 
soft  qui  1  which  had  been  shattered  by  being  trod- 
den upon.  It  occurred  in  Dr.  Jones  and  Dr.  Do- 
bell,  and  in  several  other  persons  who  had  been 
worn  down  by  great  fatigue,  and  it  was>  in  every 
instance,  followed  by  a  fatal  issue  of  the  fever.  In 
Dr.  Jones  this  state  of  the  pulse  was  accompanied 
with  such  a  difficulty  of  breathing,  that  every  breath 
he  drew,  on  the  day  of  his  attack,  he  informed  me, 
was  the  effort  of  a  sigh.  He  died  on  the  17th  of 
September,  and  on  the  sixth  day  of  his  fever. 

The  action  of  the  arteries  was,  as  usual,  very  ir- 
regular in  many  cases.  In  some  there  was  a  dis- 
tressing throbbing  of  the  vessels  in  the  brain,  and 
in  one  of  my  patients  a  similar  sensation  in.  the  bow- 
els, but  without  pain.  Many  people  had  issues  of 
blood  from  their  blisters  in  this  fever. 


BILIOUS    YELLOW    FEVER    OF    1797.  15 

I  saw  nothing  new  in  the  effects  of  the  fever 
upon  the  liver,  lungs,  brain,  nor  upon  the  stomach 
and  bowels. 

II.  The  excretions  were  distinguished  by  no  un- 
usual marks.  I  met  with  no  recoveries  where  there 
were  not  black  stools.  They  excoriated  the  rectum 
in  Dr.  Way.  It  was  a  happy  circumstance  where 
morbid  bilious  matter  came  away  in  the  beginning 
of  the  disease.  But  it  frequently  resisted  the 
most  powerful  cathartics  until  the  5th  or  7th  day  of 
the  fever,  at  which  time  it  appeared  rather  to  yield 
to  the  disorganization  of  the  liver  than  to  medi- 
cine. Where  sufficient  blood-letting  had  been  pre- 
vious y  used,  the  patient  frequently  recovered,  even 
after  the  black  discharges  from  the  bowels  took 
place  in  a  late  stage  of  the  disease. 

Dr.  Coxe  informed  me,  that  he  attended  a  child 
of  seventeen  months  old  which  had  white  stools  for 
several  days.  Towards  the  close  of  its  disease  it 
had  black  stools,  and  soon  afterwards  died. 

Several  of  my  patients  discharged  worms  during 
the  fever.  In  one  instance  they  were  discharged 
from  the  mouth. 


K 


16  AN    ACCOUNT    OF    THE 

A  preternatural  frequency  in  making  pale  water 
attended  the  first  attack  of  the  disease  in  Mr.  Jo- 
seph Fisher. 

A  discharge  of  an  unusual  quantity  of  urine  pre- 
ceded, a  few  hours,  the  death  of  the  daughter  of 
Mrs.  Read. 

i 

In  two  of  my  patients  there  was  a  total  suppres. 
sion  of  urine.  In  one  of  them  it  continued  five 
days  without  exciting  any  pain. 

There  was  no  disposition  to  sweat  after  the  first 
and  second  days  of  the  fever.  Even  in  those  states 
of  the  fever,  in  which  the  intermissions  were  most 
complete,  there  was  seldom  any  moisture,  or  even 
softness  on  the  skin.  This  was  so  characteristic  of 
malignity  in  the  bilious  fever,  that  where  I  found 
the  opposite  state  of  the  skin,  towards  the  close  of  a 
paroxysm,  I  did  not  hesitate  to  encourage  my  pa- 
tient, by  assuring  him  that  his  fever  was  of  a  mild 
nature,  and  would  most  probably  be  safe  in  its 
issue. 

III.  I  saw  no  unusual  marks  of  the  disease  in 
the  nervous  system.  The  mind  was  seldom  affected 
bv  delirium  after  the  loss  of  blood.     There  was  a 


BILIOUS    YELLOW    FEVER    OF    1797.  17 

disposition  to  shed  tears  in  two  of  my  patients. 
One  of  them  wept  during  the  whole  time  of  a  pa- 
roxysm of  the  fever.  In  one  case  I  observed  an 
uncommon  dulness  of  apprehension,  with  no  other 
mark  of  a  diseased  state  of  the  mind.  It  was  in  a 
man  whose  faculties,  in  ordinary  health,  acted  with 
celerity  and  vigour. 

Dr.  Caldwell  informed  me  of  a  singular  change 
which  took  place  in  the  operations  of  his  mind 
during  his  recovery  from  the  fever.  His  imagina- 
tion carried  him  back  to  an  early  period  of  his  life, 
and  engaged  him,  for  a  day  or  two,  in  playing  with 
a  bow  and  arrow,  and  in  amusements  of  which  he 
had  been  fond  when  a  boy.  A  similar  change  oc- 
curred in  the  mind  of  my  former  pupil,  Dr.  Fisher, 
during  his  convalescence  from  the  yellow  fever  in 
1793.  He  amused  himself  for  two  days  in  looking 
over  the  pictures  of  a  family  Bible  which  lay  in  his 
room,  and  declared  that  he  found  the  same  kind  of 
pleasure  in  this  employment  that  he  did  when  a 
child.  However  uninteresting  these  facts  may  now 
appear,  the  time  will  come  when  they  may  proba- 
bly furnish  useful  hints  for  completing  the  physio- 
logy and  pathology  of  the  mind. 

Where  blood-letting  had  not  been  used,  patients 
frequently  died  of  convulsions. 
vol.  iv.  c 


18  AN    ACCOUNT    OF    THE 


IV".  The  senses  of  seeing  and  feeling  were  im- 
paired in  several  cases,  Mrs.  Bradford's  vision 
was  so  weak  that  she  hardly  knew  her  friends  at  her 
bed-side.  I  had  great  pleasure  in  observing  this 
alarming  symptom  suddenly  yield  to  the  loss  of 
four  ounces  of  blood. 

Several  persons  who  died  of  this  fever  did  not, 
from  the  beginning  to  the  end  of  the  disease,  feel 
any  pain.  I  shall  hereafter  endeavour  to  explain 
the  cause  of  this  insensible  state  of  the  nerves. 

The  appetite  for  food  was  unimpaired  for  three 
days  in  Mr.  Andrew  Brown,  at  a  time  when  his 
pulse  indicated  a  high  grade  of  the  fever.  I  heard 
of  several  persons  who  ate  with  avidity  just  before 
they  died. 

V.  Glandular  swellings  were  very  uncommon  in 
this  fever.  I  should  have  ascribed  their  absence  to 
the  copious  use  of  depleting  remedies  in  my  prac- 
tice, had  I  not  been  informed  that  morbid  affections 
of  the  lymphatic  glands  were  unknown  in  the  city 
hospital,  where  blood-letting  was  seldom  used,  and 
where  the  patients,  in  many  instances,  died  before 
they  had  time  to  take  medicine  of  any  kind, 


BILIOUS    YELLOW    FEVER    OF    1797.  19 

VI.  The  skin  was  cool,  dry,  smooth,  and  even 
shining  in  some  cases.  Yellowness  was  not  uni- 
versal. Those  small  red  spots,  which  have  been 
compared  to  moscheto  bites,  occurred  in  several 
of  my  patients.  Dr.  John  Duffield,  who  acted  as 
house  surgeon  and  apothecary  at  the  city  hospital, 
informed  me  that  he  saw  vibices  on  the  skin  in 
many  cases,  and  that  they  were  all  more  or  less 
sore  to  the  touch. 

VII.  The  blood  was  dissolved  in  a  few  cases. 
That  appearance  of  the  blood,  which  has  been  com- 
pared to  the  washings  of  flesh,  was  very  common. 
It  was  more  or  less  sizy  towards  the  close  of  the 
disease  in  most  cases.  I  have  suspected,  from  this 
circumstance,  that  this  mark  of  ordinary  morbid 
action  or  inflammation  was  in  part  the  effect  of  the 
mercury  acting  upon  the  blood-vessels.  It  is  well 
known  that  sizy  blood  generally  accompanies  a  sa- 
livation. IF  this  conjecture  be  well  founded,  it  will 
not  militate  against  the  use  of  mercury  in  malignant 
fevers,  for  it  shows  that  this  valuable  medicine  pos- 
sesses a  power  of  changing  an  extraordinary  and 
dangerous  degree  of  morbid  action  in  the  blood- 
vessels to  that  which  is  more  common  and  safe.  I 
have  seldom  seen  a  yellow  fever  terminate  fatally 
after  the  appearance  of  sizy  blood. 


JO  AN    ACCOUNT    OF    THE 

Dr.  Stewart  informed  me,  that  in  those  cases  in 
which  the  serum  of  the  blood  had  a  yellow  colour, 
it  imparted  a  saline  taste  only  to  his  tongue.  He 
was  the  more  struck  with  this  fact,  as  he  perceived 
a  strong  bitter  state  upon  his  skin,  in  a  severe  at- 
tack of  the  yellow  fever  in  1793. 

I  proceed  next  to  take  notice  of  the  type  of  the 
fever. 

In  many  cases,  it  appeared  in  the  form  of  a  re- 
mitting and  intermitting  fever.  The  quotidian  and 
tertian  forms  were  most  common.  In  Mr.  Robert 
Wharton,  it  appeared  in  the  form  of  a  quartan. 
But  it  frequently  assumed  the  character  which  is 
given  of  the  same  fever  in  Charleston,  by  Dr.  Lin- 
ing. It  came  on  without  chills,  and  continued 
without  any  remission  for  three  days,  after  which 
the  patient  believed  himself  to  be  well,  and  some- 
times rose  from  his  bed,  and  applied  to  business. 
On  the  fourth  or  fifth  day,  the  fever  returned,  and 
unless  copious  evacuations  had  been  used  in  the 
early  stage  of  the  disease,  it  generally  proved  fatal. 
Sometimes  the  powers  of  the  system  were  depressed 
below  the-  return  of  active  fever,  and  the  patient 
sunk  away  by  an  easy  death,  without  pain,  heat,  or 
a  quick  pulse.  I  have  been  much  puzzled  to  dis- 
tinguish a  crisis  of  the  fever  on  the  third  or  fourth 


/ 

BILIOUS    YELLOW    FEVER    OF     1797.  21 

day,  from  the  insidious  appearance  which  has  been 
described.  It  deceived  me  in  1793.  It  may  be 
known  by  a  preternatural  coolness  in  the  skin,  and 
languor  in  the  pulse,  by  an  inability  to  sit  up  long 
without  fatigue  or  faintness,  by  a  dull  eye,  and  by 
great  depression  of  mind,  or  such  a  flow  of  spirits 
as  sometimes  to  produce  a  declaration  from  the 
patient  that  "  he  feels  too  well."  Where  these 
symptoms  appear,  the  patient  should  be  informed 
of  his  danger,  and  urged  to  the  continuance  of  such 
remedies  as  are  proper  for  him. 

The  following  states  or  forms  were  observable 
in  the  fever : 

1.  In  a  few  cases,  the  miasmata  produced  death 
in  four  and  twenty  hours,  with  convulsions,  coma, 
or  apoplexy. 

2.  There  were  open  cases,  in  which  the  pulse  was 
full  and  tense  as  in  a  pleurisy  or  rheumatism,  from 
the  beginning  to  the  end  of  the  fever.  They  were 
generally  attended  with  a  good  deal  of  pain. 

3.  There  were  depressed  or  locked  cases,  in 
which  there  were  a  sense  of  great  debility,  but 
little  or  no  pain,  a  depressed  and  slow  pulse,  a  cool 


22  AN    ACCOUNT    OF    THE 

skin,  cold  hands  and  feet,  and  obstructed  excre- 
tions. 

4.  There  were  divided  or  mixed  cases,  in  which 
the  pulse  was  active  until  the  4th  day,  after  which 
it  became  depressed.  All  the  other  symptoms  of 
the  locked  state  of  the  fever  accompanied  this  de- 
pressed state  of  the  pulse, 

5.  There  were  cases  in  which  the  pulse  imparted 
a  perception  like  that  of  a  soft  and  shattered  quill. 
I  have  before  mentioned  that  this  state  of  the  pulse 
occurred  in  Dr.  Jones  and  Dr.  Dobell.  I  felt  it  but 
once,  and  on  the  day  of  his  attack,  in  the  latter 
gentleman,  and  expressed  my  opinion  of  his  ex- 
treme danger  to  one  of  my  pupils  upon  my  return 
from  visiting  him.  I  did  not  meet  with  a  case 
which  terminated  favourably,  where  I  perceived  this 
shattered  pulse.  A  disposition  to  sweat  occurred 
in  this  state  of  the  fever. 

6.  There  were  what  Dr.  Caldwell  happily  called 
walking  cases.  The  patients  here  were  flushed  or 
pale,  had  a  full  or  tense  pulse,  but  complained  of  no 
pain,  had  a  good  appetite,  and  walked  about  their 
rooms  or  houses,  as  if  thev  were  but  little  indis- 
posed,  until  a  day  or  two,  and,  in  some  instances, 
until  a  few  hours  before  they  died.     We  speak  of 


BILIOUS    YELLOW    FEVER    OF    1797.  23 

a  dumb  gout  and  dumb  rheumatism;  with  equal 
propriety,  the  epithet  might  be  applied  to  this  form 
of  yellow  fever  in  its  early  stage.  The  impression 
of  the  remote  cause  of  the  fever,  in  these  cases, 
was  beyond  sensation,  for,  upon  removing  a  part  of 
it  by  bleeding  or  purging,  the  patients  complained 
of  pain,  and  the  excitement  of  the  muscles  passed 
so  completely  into  the  blood-vessels  and  alimentary 
canal,  as  to  convert  the  fever  into  a  common  and 
more  natural  form.  These  cases  were  always  dan- 
gerous, and,  when  neglected,  generally  terminated 
in  death.  Mr.  Brown's  fever  came  on  in  this  insi- 
dious shape.  It  was  cured  by  the  loss  of  upwards 
of  100  ounces  of  blood,  and  a  plentiful  salivation. 

7.  There  was  the  intermitting  form  in  this  fever. 
This,  like  the  last,  often  deceived  the  patient,  by 
leading  him  to  suppose  his  disease  was  of  a  com- 
mon or  trifling  nature.  It  prevented  Mr.  Richard 
Smith  from  applying  for  medical  aid  in  an  attack  of 
the  fever  for  several  days,  by  which  means  it  made 
such  an  impression  upon  his  viscera,  that  depleting 
remedies  were  in  vain  used  to  cure  him.  He  died 
in  the  prime  of  life,  beloved  and  lamented  by  a  nu- 
merous circle  of  relations  and  friends. 

8.  There  was  a  form  of  this  fever  in  which  it  re- 
sembled the  mild  remittent  of  common  seasons. 


24  AN    ACCOUNT    OP    THE 

It  was  distinguished  from  it  chiefly  by  the  black 
colour  of  the  intestinal  evacuations. 

9.  There  were  cases  of  this  fever  so  light,  that 
patients  were  said  to  be  neither  sick  nor  well ;  or, 
in  other  words,  they  were  sick  and  well  half  a  do- 
zen times  in  a  day.  Such  persons  walked  about, 
and  transacted  their  ordinary  business,  but  com- 
plained of  dulness,  and,  occasionally,  of  shooting 
pains  in  their  heads.  Sometimes  the  stomach  was 
affected  with  sickness,  and  the  bowels  with  diar- 
rhoea or  costiveness.  All  of  them  complained  of 
night  sweats.  The  pulse  was  quicker  than  natural, 
but  seldom  had  that  convulsive  action  which  consti- 
tutes fever.  Purges  always  brought  away  black 
stools  from  such  patients,  and  this  circumstance 
served  to  establish  its  relationship  to  the  prevailing 
epidemic.  Now  and  then,  by  neglect  or  improper 
treatment,  it  assumed  a  higher  and  more  danger- 
ous grade  of  the  fever,  and  became  fatal,  but  it  more 
commonly  yielded  to  nature,  or  to  a  single  dose  of 
purging  physic. 

10.  There  were  a  few  cases  in  which  the  skin 
was  affected  with  universal  yellowness,  but  without 
more  pain  or  indisposition  than  usually  occurs  in 
the  jaundice.    They  were  very  frequent  in  the  year 


BILIOUS    YELLOW    FEVER    OF    1797.  25 

1793,  and  generally  prevail  in  the  autumn,  in  all 
places  subject  to  bilious  fever. 

11.  There  were  chronic  cases  of  this  fever.  It 
is  from  the  want  of  observation  that  physicians  limit 
the  duration  of  the  yellow  fever  to  certain  days.  I 
have  seen  many  instances  in  which  it  has  been  pro- 
tracted into  what  is  called  by  authors  a  slow  ner- 
vous fever.  The  wife  of  captain  Peter  Bell  died 
with  a  black  vomiting  after  an  illness  of  nearly  one 
month.  Dr.  Pinckard,  formerly  one  of  the  physi- 
cians of  the  British  army  in  the  West- Indies,  in  a 
late  visit  to  this  city  informed  me,  that  he  had  often 
seen  the  yellow  fever  put  on  a  chronic  form  in  the 
West- India  islands. 

In  delivering  this  detail  of  the  various  forms  of 
the  yellow  fever,  I  am  aware  that  I  oppose  the  opi- 
nions of  many  of  my  medical  brethren,  who  ascribe 
to  it  a  certain  uniform  character,  which  is  removed 
beyond  the  influence  of  climate,  habit,  predisposi- 
tion, and  the  different  strength  and  combinations  of 
remote  and  exciting  causes. ;  This  uniformity  in 
the  symptoms  of  this  fever  is  said  to  exist  in  the 
West- Indies,  and  every  deviation  from  it  in  the 
United  States  is  called  by  another  name.  The  fol- 
lowing communication,  which  I  received  from  Dr. 
Pinckard,  will  show  that  this  disease  is  as  different 

VOL.  IV«  © 


26  AN    ACCOUNT    OF    THE 

in  its  forms  in  the  West-Indies  as  it  is  in  this  coun- 
try. 

"  The  yellow  fever,  as  it  appeared  among  the 
"  troops  in  Guiana  and  the  West- India  islands,  in 
"  the  years  1796  and  1797,  exhibited  such  perpe- 
"  tual  instability,  and  varied  so  incessantly  in  its 
"  character,  that  I  could  not  discover  any  one 
"  symptom  to  be  decidedly  diagnostic  ;  and  hence 
"  I  have  been  led  into  an  opinion  that  the  yellow 
"  fever,  so  called,  is  not  a  distinct  or  specific  dis- 
"  ease,  but  merely  an  aggravated  degree  of  the 
"  common  remittent  or  bilious  fever  of  hot  cli- 
"  mates,  rendered  irregular  in  form,  and  augmented 
"  in  malignity,  from  appearing  in  subjects  unac- 
"  customed  to  the  climate. 

"  Philadelphia,  January  12th,  1798. " 

Many  other  authorities  equally  respectable  with 
Dr.  Pinckard's,  among  whom  are  Pringle,  Huck, 
and  Hunter,  might  be  adduced  in  support  of  the 
unity  of  bilious  fever.  But  to  multiply  them  fur- 
ther would  be  an  act  of  homage  to  the  weakness  of 
human  reason,  and  an  acknowledgment  of  the  in- 
fant state  of  our  knowledge  in  medicine.  As  well 
might  we  suppose  nature  to  be  an  artist,  and  that 
diseases  were  shaped  by  her  like  a  piece  of  statuary. 


BILIOUS    YELLOW    FEVER    OF    1797.  27 

or  a  suit  of  clothes,  by  means  of  a  chissel,  or  pair 
of  scissars,  as  admit  every  different  form  and  grade 
of  morbid  action  in  the  system  to  be  a  distinct  dis- 
ease. 

Notwithstanding  the  fever  put  on  the  eleven 
forms  which  have  been  described,  the  moderate 
cases  were  few,  compared  with  those  of  a  malig- 
nant and  dangerous  nature.  It  was  upon  this  ac- 
count that  the  mortality  was  greater  in  the  same 
number  of  patients,  who  were  treated  with  the  same 
remedies,  than  it  was  in  the  years  1793  and  1794. 
The  disease,  moreover,  partook  of  a  more  malig- 
nant character  than  the  two  epidemics  that  have 
been  mentioned.  The  yellow  fever  in  Norfolk, 
Drs.  Taylor  and  Hansford  informed  me,  in  a  letter 
I  received  from  them,  was  much  more  malignant 
and  fatal,  under  equal  circumstances,  than  it  was  in 
1795. 

There  were  evident  marks  of  the  disease  attack- 
ing more  persons  three  days  before,  and  three  days 
after  the  full  and  change  of  the  moon,  and  of  more 
deaths  occurring  at  those  periods  than  at  any  other 
time.  The  same  thing  has  been  remarked  in  the 
plague  by  Diemerbroeck,  in  the  fevers  of  Bengal 
by  Dr.  Balfour,  and  in  those  of  Demarara  by  Dr. 
Pinckard. 


28  AN    ACCOUNT    OF    THE 

During  the  prevalence  of  the  fever  I  attended  the 
following  persons  who  had  been  affected  by  the  epi- 
demic of  1793,  viz.  Dr.  Physick,  Thomas  Learn- 
ing, Thomas  Can  by,  Samuel  Bradford,  and  George 
Loxley,  also  Mrs.  Eggar,  who  had  a  violent  attack 
of  it  in  the  year  1794.  Samuel  Bradford  was  like- 
wise affected  by  it  in  1794. 

During  my  intercourse  with  the  sick,  I  felt  the 
miasmata  of  the  fever  operate  upon  my  system  in 
the  most  sensible  manner.  It  produced  languor,  a 
pain  in  my  head,  and  sickness  at  my  stomach.  A 
sighing  attended  me  occasionally,  for  upwards  of 
two  weeks.  This  symptom  left  me  suddenly,  and 
was  succeeded  bv  a  hoarseness,  and,  at  times,  with 
such  a  feebleness  in  my  voice  as  to  make  speaking 
painful  to  me.  Having  observed  this  affection  of 
the  trachea  to  be  a  precursor  of  the  fever  in  several 
cases,  it  kept  me  under  daily  apprehensions  of  be- 
ing confined  by  it.  It  gradually  went  off  after  the 
first  of  October.  I  ascribed  my  recovery  from  it, 
and  a  sudden  diminution  of  the  effects  of  the  mias- 
mata upon  my  system,  to  a  change  produced  in  the 
atmosphere  by  the  rain  which  fell  on  that  day. 

The  peculiar  matter  emitted  by  the  breath  or 
perspiration  of  persons  affected  by  this  fever,  in- 
duced a  sneezing  in  Dr.  Dobell,  every  time  he  went 


BILIOUS    YELLOW    FEVER    OF    1797.         29 

into  a  sick  room.  Ambrose  Parey  says  the  same 
thing  occurred  to  him,  upon  entering  the  room  of. 
patients  confined  by  the  plague. 

The  gutters  emitted,  in  many  places,  a  sulphure- 
ous smell  during  the  prevalence  of  the  fever.  Up- 
on rubbing  my  hands  together  I  could  at  any  time 
excite  a  similar  smell  in  them.  I  have  taken  notice 
of  this  effect  of  the  matters  which  produced  the  dis- 
ease upon  the  body,  in  the  year  1794. 

In  order  to  prevent  an  attack  of  the  fever,  I  care- 
fully avoided  all  its  exciting  causes.  I  reduced  my 
diet,  and  lived  sparingly  upon  tea,  coffee,  milk, 
and  the  common  fruits  and  garden  vegetables  of 
the  season,  with  a  small  quantity  of  salted  meat, 
and  smoked  herring.  My  drinks  were  milk  and 
water,  weak  claret  and  water,  and  weak  porter  and 
water.  I  sheltered  myself  as  much  as  possible  from 
the  rays  of  the  sun,  and  from  the  action  of  the  eve- 
ning air,  and  accommodated  my  dress  to  the  changes 
in  the  temperature  of  the  atmosphere.  By  similar 
means,  I  have  reason  to  believe,  many  hundred 
people  escaped  the  disease,  who  were  constantly 
exposed  to  it. 

The  number  of  deaths  by  the  fever,  in  the  months 
of  August,  September,  and  October,  amounted  to 


30  AN    ACCOUNT    OF    THE 

between  ten  and  eleven  hundred.  In  the  list  of  the 
dead  were  nine  practitioners  of  physic,  several  of 
whom  were  gentlemen  of  the  most  respectable  cha- 
racters. This  number  will  be  thought  considerable 
when  it  is  added,  that  not  more  than  three  or  four 
and  twenty  physicians  attended  patients  in  the  dis- 
ease. Of  the  survivors  of  that  number,  eight  were 
affected  with  the  fever.  This  extraordinary  mor- 
tality and  sickness  among  the  physicians  must  be 
ascribed  to  their  uncommon  fatigue  in  attending 
upon  the  sick,  and  to  their  inability  to  command 
their  time  and  labours,  so  as  to  avoid  the  exciting 
causes  of  the  fever. 

Among  the  medical  gentlemen  whose  deaths 
have  been  mentioned,  was  my  excellent  friend,  Dr. 
Nicholas  Way.  I  shall  carry  to  my  grave  an  affec- 
tionate remembrance  of  him.  We  passed  our 
youth  together  in  the  study  of  medicine,  and  lived 
to  the  time  of  his  death  in  the  habits  of  the  tender- 
est  friendship.  In  the  year  1794,  he  removed  from 
Wilmington,  in  the  Delaware  state,  to  Philadelphia, 
where  his  talents  and  manners  soon  introduced  him 
into  extensive  business.  His  independent  fortune 
furnished  his  friends  with  arguments  to  advise  him 
to  retire  from  the  city,  upon  the  first  appearance  of 
the  fever.  But  his  humanity  prevailed  over  the 
dictates  of  interest  and  the  love  of  life.     He  was 


BILIOUS    YELLOW    FEVER    OF     1797.  31 

active  and  intelligent  in  suggesting  and  executing 
plans  to  arrest  the  progress  of  the  disease,  and  to 
lessen  the  distresses  of  the  poor.  On  the  27th  of 
August,  he  was  seized,  after  a  ride  from  the  coun- 
try in  the  evening  air,  with  a  chilly  fit  and  fever. 
I  saw  him  the  next  day,  and  advised  the  usual  de- 
pleting remedies.  He  submitted  to  my  prescrip- 
tions with  reluctance,  and  in  a  sparing  manner, 
from  an  opinion  that  his  fever  was  nothing  but  a 
common  remittent.  To  enforce  obedience  to  my 
advice,  I  called  upon  Dr.  Griffitts  to  visit  him  with 
me.  Our  combined  exertions  to  overcome  his 
prejudices  against  our  remedies  were  ineffectual. 
At  two  o'clock  in  the  afternoon,  on  the  sixth  day 
of  his  disease,  with  an  aching  heart  I  saw  the  sweat 
of  death  upon  his  forehead,  and  felt  his  cold  arm 
without  a  pulse.  He  spoke  to  me  with  difficulty  : 
upon  my  rising  from  his  bed-side  to  leave  him,  his 
eyes  filled  with  tears,  and  his  countenance  spoke  a 
language  which  I  am  unable  to  describe.  I  pro- 
mised to  return  in  a  short  time,  with  a  view  of  at- 
tending the  last  scene  of  his  life.  Immediately 
after  I  left  his  room,  he  went  aloud.  I  returned 
hastily  to  him,  and  found  him  in  convulsions.  He 
died  a  few  hours  afterwards.  Had  I  met  with  no 
other  affliction  in  the  autumn  of  1 797  than  that  which 
I  experienced  from  this  affecting  scene,  it  would 
have  been  a  severe  one ;  but  it  was  a  part  only  of 


32  AN"    ACCOUNT    OF    THE 

what  I  suffered  from  the  death  of  other  friends,  and 
from  the  malice  of  enemies. 

I  beg  the  reader's  pardon  for  this  digression.  It 
shall  be  the  last  time  and  place  in  which  any  notice 
shall  be  taken  of  my  sorrows  and  persecutions  in 
the  course  of  these  volumes. 

Soon  after  the  citizens  returned  from  the  coun- 
try, the  governor  of  the  state,  Mr.  Mifflin,  addressed 
a  letter  to  the  college  of  physicians  of  Philadelphia, 
requesting  to  know  the  origin,  progress,  and  nature 
of  the  fever  which  had  recently  afflicted  the  city, 
and  the  means  of  preventing  its  return.  He  ad- 
dressed a  similar  letter  to  me,  to  be  communicated 
to  such  gentlemen  of  the  faculty  of  medicine,  as 
were  not  members  of  the  college  of  physicians. 

The  college,  in  a  memorial  to  the  legislature  of 
the  state,  asserted  that  the  fever  had  been  imported 
in  two  ships,  the  one  from  Havannah,  the  other 
from  Port  au  Prince,  and  recommended,  as  the 
most  effectual  means  of  preventing  its  recurrence, 
a  more  rigid  quarantine  law. 

The  gentlemen  of  the  faculty  of  medicine,  thir- 
teen in  number,  in  two  letters  to  the  governor  of 
the  state,  the  one  in  their  private  capacity,  and  the 


BILIOUS    YELLOW    FEVER    OF    1797.  SB 

other  after  they  had  associated  themselves  into  an 
"  Academy  of  Medicine,"  asserted  that  the  fever 
had  originated  from  the  putrid  exhalations  from  the 
gutters  and  streets  of  the  city,  and  from  ponds  and 
marshy  grounds  in  its  neighbourhood ;  also  from 
the  foul  air  of  two  ships,  the  one  from  Marseilles 
and  the  other  from  Hamburgh.  They  enumerated 
all  the  common  sources  of  malignant  fevers,  and 
•recommended  the  removal  of  them  from  the  city, 
as  the  most  effectual  method  of  preventing  the  re- 
turn of  the  fever.  These  sources  of  fever,  and  the 
various  means  of  destroying  them,  shall  be  men- 
tioned in  another  place. 

I  proceed  now  to  say  a  few  words  upon  the 
treatment  which  was  used  in  this  fever.  It  was, 
in  general,  the  same  as  that  which  was  pursued  in 
the  fevers  of  1793  and  1794. 

I  began  the  cure,  in  most  cases,  by  bleedings 
when  I  was  called  on  the  first  day  of  the  disease, 
and  was  happy  in  observing  its  usual  salutary  ef- 
fects in  its  early  stage.  On  the  second  day,  it  fre- 
quently failed  of  doing  service,  and  on  the  subse- 
quent days  of  the  fever,  I  believe,  it  often  did 
harm ;  more  especially  if  no  other  depleting  reme- 
dy had  preceded  it.  The  violent  action  of  the 
blood-vessels  in  this  disease,  when  left  to  itself  for 

VOL.   IV.  e 


34  AN    ACCOUNT    OF    THE 

two  or  three  days,  fills  and  suffocates  the  viscera 
with  such  an  immense  mass  of  blood,  as  to  leave  a 
quantity  in  the  vessels  so  small,  as  barely  to  keep 
up  the  actions  of  life.  By  abstracting  but  a  few 
ounces  of  this  circulating  blood,  we  precipitate 
death.  In  those  cases  where  a  doubt  is  entertained 
of  such  an  engorgement  of  stagnating  blood  having 
taken  place,  it  will  always  be  safest  to  take  but 
three  or  four  ounces  at  a  time,  and  to  repeat  it  four 
or  five  times  a- day.  By  this  mode  of  bleeding,  we 
give  the  viscera  an  opportunity  of  emptying  their 
superfluous  blood  into  the  vessels,  and  thereby  pre- 
vent their  collapsing,  from  the  sudden  abstraction 
of  the  stimulus  which  remained  in  them.  I  con- 
fine this  observation  upon  bleeding,  after  the  first 
stage  of  the  disease,  only  to  the  epidemic  of  1797. 
It  was  frequently  effectual  when  used  for  the  first 
time  after  the  first  and  second  days,  in  the  fevers  of 
1793  and  1794,  and  it  is  often  useful  in  the  ad- 
vanced stage  of  the  common  bilious  fever.  The 
different  and  contradictory  accounts  of  the  effects 
of  bleeding  in  the  yellow  fever,  in  the  West- Indies, 
probably  originate  in  its  being  used  in  different 
staees  of  the  disease.  Dr.  Jackson,  of  the  British 
army,  in  his  late  visit  to  Philadelphia,  informed  me, 
that  lie  had  cured  nineteen  out  of  twenty  of  all  the 
soldiers  whom  he  attended,  by  copious  bleeding, 
provided  it  was  performed  within  six  hours  after 


BILIOUS    YELLOW    FEVER    OF    1797.  35 

the  attack  of  the  fever.  Beyond  that  period,  it  mi- 
tigated its  force,  but  seldom  cured.  The  quantity 
of  blood  drawn  by  the  doctor,  in  this  early  stage  of 
the  disease,  was  always  from  twenty  to  thirty 
ounces.  I  have  said  the  yellow  fever  of  1797  was 
more  malignant  than  the  fevers  of  1793  and  1794. 
Its  resemblance  to  the  yellow  fever  in  the  West- 
Indies,  in  not  yielding  to  bleeding  after  the  first 
day,  is  a  proof  of  this  assertion. 

I  was  struck,  during  my  attendance  upon  this 
fever,  in  observing  the  analogy  between  its  mixed 
form  and  the  malignant  state  of  the  small- pox. 
The  fever,  in  both,  continues  for  three  or  four 
days  without  any  remission.  They  both  have  a 
second  stage,  in  which  death  usually  takes  place, 
if  the  diseases  be  left  to  themselves.  Bv  means  of 
copious  bleeding  in  their  first,  they  are  generally 
deprived  of  their  malignity  and  mortality  in  their 
second  stage.  This  remark,  so  trite  in  the  small- 
pox, has  been  less  attended  to  in  the  yellow  fever. 
The  bleeding  in  the  first  stage  of  this  disease  does 
not,  it  is  true,  destroy  k  altogether,  any  more  than 
it  destroys  an  eruption  in  the  second  stage  of  the 
small-pox,  but  it  weakens  it  in  such  a  manner  that 
the  patient  passes  through  its  second  stage  without 
pain  or  danger,  and  with  no  other  aid  from  medi- 
cine than  what  is  commonly  derived  from  good 


36  AN   ACCOUNT   OF    THE 

nursing,  proper  aliment,  and  a  little  gently  opening 
physic. 

It  is  common  with  those  practitioners  who  object 
to  bleeding  in  the  yellow  fever,  to  admit  it  occasion^ 
ally  in  robust  habits.  This  rule  leads  to  great  error 
in  practice.  From  the  weak  action  of  predisposing, 
or  exciting  causes,  the  disease  often  exists  in  a  fee- 
ble state  in  such  habits,  while  from  the  protracted 
or  violent  operation  of  the  same  causes,  it  appears 
in  great  force  in  persons  of  delicate  constitutions. 
A  physician,  therefore,  in  prescribing  for  a  patient 
in  t.  is  fever,  should  forget  the  natural  strength  of 
his  muscles,  and  accommodate  the  loss  of  blood 
wholly  to  the  morbid  strength  of  his  disease. 

The  quantity  of  blood  drawn  in  this  fever  was  al- 
ways  proportioned  to  its  violence.  I  cured  many 
by  a  single  bleeding.  A  few  required  the  loss  of 
upwards  of  a  hundred  ounces  of  blood  to  cure 
them.  The  persons  from  whom  that  large  quantity 
of  blood  was  taken,  were,  Messieurs  Andrew 
Brown,  Horace  Hall,  George  Cummins,  J.  Ramsay, 
and  George  Eyre.  But  I  wras  not  singular  in  the 
liberal  and  frequent  use  of  the  lancet.  The  follow- 
ing physicians  drew  the  quantities  of  blood  annex- 
ed to  their  respective  names  from  the  following  per- 
sons, viz, 


BILIOUS    YELLOW    FEVER    OF     1797,  37 

Dr.  Dewees  176  ounces  from  Dr.  Physick, 

Dr.  Griffitts  1 10  Mr.  S.  Thomson, 

Dr.  Stewart  106  Mrs.  M'Phail, 

Dr.  Cooper  150  Mr.  David  Evans, 

Dr.  Gillespie  103  himself. 

All  the  above  named  persons  had  a  rapid  and 
easy  recovery,  and  now  enjoy  good  health.  I  lost 
but  one  patient  who  had  been  the  subject  of  early- 
and  copious  bleeding.  His  death  was  evidently 
induced  by  a  supper  of  beef- stakes  and  porter,  after 
he  had  exhibited  the  most  promising  signs  of  con- 
valescence. 


OF  PURGING. 

From  the  great  difficulty  that  was  found  in  dis- 
charging bile  from  the  bowels,  by  the  common 
modes  of  administering  purges,  Dr.  Griffitts  sug- 
gested to  me  the  propriety  of  giving  large  doses  of 
calomel,  without  jalap  or  any  other  purging  medi- 
cine, in  order  to  loosen  the  bile  from  its  close  con- 
nection with  the  gall-bladder  and  duodenum,  dur- 
ing the  first  day  of  the  disease.     This  method  of 


38  AN    ACCOUNT    OF    THE 

discharging  acrid  bile  was  found  useful.  I  ob- 
served the  same  relief  from  large  evacuations  of 
foetid  bile,  in  the  epidemic  of  1797,  that  I  have  re- 
marked in  the  fever  of  1793.  Mr.  Bryce  has 
taken  notice  of  the  same  salutary  effects  from  simi- 
lar evacuations,  in  the  yellow  fever  on  board  the 
Busbridge  Indiaman,  in  the  year  1792.  His  words 
are :  "It  was  observable,  that  the  more  dark-co- 
loured and  foetid  such  discharges  were,  the  more 
early  and  certainly  did  the  symptoms  disappear. 
Their  good  effects  were  so  instantaneous,  that  I 
have  often  seen  a  man  carried  up  on  deck,  perfectly 
delirious  with  subsultus  tendinum,  and  in  a  state  of 
the  greatest  apparent  debility,  who,  after  one  or 
two  copious  evacuations  of  this  kind,  has  returned 
of  himself,  and  astonished  at  his  newly  acquired 
strength*."  Very  different  are  the  effects  of  tonic 
remedies,  when  given  to  remove  this  apparent  de- 
bility. The  clown  who  supposes  the  crooked  ap- 
pearance of  a  stick,  when  thrust  into  a  pail  of  water, 
to  be  real,  does  not  err  more  against  the  laws  of 
light,  than  that  physician  errs  against  a  law  of  the 
animal  economy,  who  mistakes  the  debility  which 
arises  from  oppression  for  an  exhausted  state  of  the 
system,  and  attempts  to  remove  it  by  stimulating 
medicines. 

*  Annals  of  Medicine,  p.  123. 


BILIOUS    YELLOW    FEVER    OF    1797.  39 

After  unlocking  the  bowels,  by  means  of  calo- 
mel and  jalap,  in  the  beginning  of  the  fever,  I 
found  no  difficulty  afterwards  in  keeping  them 
gently  open  by  more  lenient  purges.  In  addition 
to  those  which  I  have  mentioned  in  the  account  of 
the  fever  of  1793,  I  yielded  to  the  advice  of  Dr. 
Griffitts,  by  adopting  the  soluble  tartar,  and  gave 
small  doses  of  it  daily  in  many  cases.  It  seldom 
offended  the  stomach,  and  generally  operated,  with- 
out griping,  in  the  most  plentiful  manner. 

However  powerful  bleeding  and  purging  were  in 
the  cure  of  this  fever,  they  often  required  the  aid  of 
a  salivation  to  assist  them  in  subduing  it. 

Besides  the  usual  methods  of  introducing  mer- 
cury into  the  system,  Dr.  Stewart  accelerated  its 
action,  by  obliging  his  patients  to  wear  socks  filled 
with  mercurial  ointment ;  and  Dr.  Gillespie  aimed 
at  the  same  thing,  by  injecting  the  ointment,  in  a 
suitable  vehicle,  into  the  bowels,  in  the  form  of 
glysters. 

The  following  fact,  communicated  to  me  by  Dr. 
Stewart,  wrill  show  the  safety  of  large  doses  of 
calomel  in  this  fever.    Mrs.  M'Phail  took  60  grains 
of  calomel,  by  mistake,  at  a  dose,  after  having  taken 
three  or  four  doses,  of  20  grains  each,  on  the  same 


40  AN    ACCOUNT    OF    THE^ 

day.  She  took,  in  all,  356  grains  in  six  days,  and 
yet,  says  the  doctor,  "  such  was  the  state  of  her 
stomach  and  intestines,  that  that  large  quantity 
was  retained  without  producing  the  least  griping, 
or  more  stools  than  she  had  when  she  took  three 
grains  every  two  hours.  J?< 

I  observed  the  mercury  to  affect  the  mouth  and 
throat  in  the  following  ways.  1.  It  sometimes  pro- 
duced a  swelling  only  in  the  throat,  resembling  a 
common  inflammatory  angina.  2.  It  sometimes 
produced  ulcers  upon  the  lips,  cheeks,  and  tongue, 
without  any  discharge  from  the  salivary  glands.  3. 
It  sometimes  produced  swellings  and  ulcers  in  the 
gums,  and  loosened  the  teeth  without  inducing  a 
salivation.  4.  There  were  instances  in  which  the 
mercury  induced  a  rigidity  in  the  masseter  muscles 
of  the  jaw,  by  which  means  the  mouth  was  kept 
constantly  open,  or  so  much  closed,  as  to  render  it 
difficult  for  the  patient  to  take  food,  and  impos- 
sible for  him  to  masticate  it.  5.  It  sometimes 
affected  the  salivary  glands  only,  producing  from 
them  a  copious  secretion  and  excretion  of  saliva. 
But,  6.  It  more  frequently  acted  upon  all  the  above 
parts,  and  it  was  then  it  produced  most  speedily  its 
salutary  effects.  7.  The  discharge  of  the  saliva 
frequently  took  place  only  during  the  remission  or 
intermission  of  the  fever,  and  ceased  with  each  re- 


BILIOUS    YELLOW    FEVER    OF    1797.  41 

turn  of  its  paroxysms.  8.  The  salivation  did  not 
take  place,  in  some  cases,  until  the  solution  of  the 
fever.  This  was  more  especially  the  case  in  those 
forms  of  the  fever  in  which  there  were  no  remis- 
sions or  intermissions.  9.  It  ceased  in  most  cases 
with  the  fever,  but  it  sometimes  continued  for  six 
weeks  or  two  months  after  the  complete  recovery 
of  the  patient.  10.  The  mercury  rarely  dislodged 
the  teeth.  Not  a  single  instance  occurred  of  a 
patient  losing  a  tooth  in  the  city  hospital,  where  the 
physicians,  Dr.  J.  Duffield  informed  me,  relied 
chiefly  upon  a  salivation  for  a  cure  of  the  fever. 
11.  Sometimes  the  mercury  produced  a  discharge 
of  blood  with  the  saliva.  Dr.  Coulter,  of  Balti- 
more, gave  me  an  account,  in  a  letter  dated  the 
17th  of  September,  1797,  of  a  boy  in  whom  a  hae- 
morrhage from  the  salivary  glands,  excited  by  calo- 
mel, was  succeeded  by  a  plentiful  flow  of  saliva, 
which  saved  his  patient.  I  saw  no  inconvenience 
from  the  mixture  of  blood  with  saliva  in  any  of  my 
patients.  It  occurred  in  Dr.  Caldwell,  Mr.  Brad- 
ford,  Mr.  Brown,  and  several  others. 

It  has  been  said  that  mercury  does  no  service 
unless  it  purges  or  salivates.  I  am  disposed  to  be- 
lieve that  it  may  act  as  a  counter  stimulus  to  that 
of  the  miasmata  of  the  yellow  fever,  and  thus  be 
useful  without  producing  any  evacuation  from  the 

T«L.    IV.  F 


42  AN    ACCOUNT    OF    THE 

bowels  or  mouth.  It  more  certainly  acts  in  this 
way,  provided  blood-letting  has  preceded  its  exhi- 
bition. I  have  supposed  the  stimulus  from  the  re- 
mote cause  of  the  yellow  fever  to  be  equal  in  force 
to  five,  and  that  of  mercury  to  three.  To  enable 
the  mercury  to  produce  its  action  upon  the  system, 
it  is  necessary  to  reduce  the  febrile  action,  by  bleed- 
ing, to  two  and  a  half,  or  below  it,  so  that  the  sti- 
mulus of  the  mercury  shall  transcend  it.  The 
safety  of  mercury,  when  introduced  into  the  system* 
has  three  advantages  as  a  stimulus  over  that  of  the 
matter  which  produces  the  fever.  1.  It  excites  an 
action  in  the  system  preternatural  only  in  force.  It 
does  not  derange  the  natural  order  of  actions.  2. 
It  determines  the  actions  chiefly  to  external  parts 
of  the  body.  And,  3.  It  fixes  them,  when  it  affects 
the  mouth  and  throat,  upon  parts  which  are  capable 
of  bearing  great  inflammation  and  effusion  without 
any  danger  to  life.  The  stimulus  which  produces 
the  yellow  fever  acts  in  ways  the  reverse  of  those 
which  have  been  mentioned.  It  produces  violent 
irregular  or  'wrong  actions.  It  determines  them  to 
internal  parts  of  the  body,  and  it  fixes  them  upon 
viscera  which  bear,  with  difficulty  and  danger,  the 
usual  effects  of  disease.  A  late  French  writer,  Dr, 
Sabre,  ascribed  to  diseases  a  centrifugal,  and  a  cen- 
tripetal direction.       From  what  has  been  said  it 


BILIOUS    YELLOW    FEVER    OF    1797.  4S 

would  seem,  the  former  belongs  to  mercury,  and 
the  latter  to  the  yellow  fever. 

Considering  the  great  prejudices  against  blood- 
letting, I  have  wished  to  combat  this  fever  with 
mercury  alone.  But,  for  reasons  formerly  given,  I 
have  been  afraid  to  trust  to  it  without  the  assistance 
of  the  lancet.  The  character  of  the  fever,  more- 
over, like  that  which  the  poet  has  ascribed  to 
Achilles,  is  of  "  so  swift,  irritable,  inexorable,  and 
"  cruel"  a  nature,  that  it  would  be  unsafe  to  rely 
exclusively  upon  a  medicine  which  is  not  only  of 
less  efficacy  than  bleeding,  but  often  slow  and  un- 
certain in  its  operation,  more  especially  upon  the 
throat  and  mouth. 

Let  not  the  reader  be  ofFended  at  my  attempts  to 
reason.  I  am  aware  of  the  evils  which  the  weak 
and  perverted  exercise  of  this  power  of  the  mind 
has  introduced  into  medicine.  But  let  us  act  with 
the  same  consistency  upon  this  subject  that  we  do 
in  other  things. 

We  do  not  consign  a  child  to  its  cradle  for  life, 
because  it  falls  in  its  first  unsuccessful  efforts  to  use 
its  legs.  In  like  manner  we  must  not  abandon  rea- 
son, because,  in  our  first  efforts  to  use  it,  we  have 
been  deceived.      A  single  just  principle  in  our 


44  AN    ACCOUNT    OT    THE 

science  will  lead  to  more  truth,  in  one  year,  than 
whole  volumes  of  uncombined  facts  will  do  in  a 
century. 

I  lost  but  two  patients  in  this  epidemic  in  whom 
the  mercury  excited  a  salivation.  One  of  them 
died  from  the  want  of  nursing ;  the  other  by  the 
late  application  of  the  remedy. 


OF  EMETICS. 

It  was  said  a  practitioner,  who  was  opposed  to 
bleeding  and  mercury,  cured  this  fever  by  means 
of  strong  emetics.  I  gave  one  to  a  man  who  refus- 
ed to  be  bled.  It  operated  freely,  and  brought  on 
a  plentiful  sweat.  The  next  day  he  arose  from  his 
bed,  and  went  to  his  work.  On  the  fourth  day  he 
sent  for  me  again.  My  son  visited  him,  and  found 
him  without  a  pulse.     He  died  the  next  day. 

I  heard  of  two  other  persons  who  took  emetics 
in  the  beginning  of  the  fever,  without  the  advice  of 
a  physician,  both  of  whom  died. 


BILIOUS    YELLOW    FEVER    OF    1797.  45 

Dr.  Pinckard  informed  me,  that  their  effects 
were  generally  hurtful  in  the  violent  grades  of  the 
yellow  fever  in  the  West- Indies.  The  same  in- 
formation  has  since  been  given  to  me  by  Dr.  Jack- 
son. In  the  second  and  third  grades  of  the  bilious 
fever  they  appear  not  only  to  be  safe,  but  useful. 


OF  DIET  AND  DRINKS. 

The  advantages  of  a  weak  vegetable  diet  were 
very  great  in  this  fever.  I  found  but  little  difficulty, 
in  most  cases,  in  having  my  prohibition  of  animal 
food  complied  with  before  the  crisis  of  the  fever, 
but  there  was  often  such  a  sudden  excitement  of 
the  appetite  for  it,  immediately  afterwards,  that  it 
was  difficult  to  restrain  it.  I  have  mentioned  the 
case  of  a  young  man,  who  was  upon  the  recovery, 
who  died  in  consequence  of  supping  upon  beef- 
stakes.  Many  other  instances  of  the  mortality  of 
this  fever  from  a  similar  cause,  I  believe,  occurred 
in  our  epidemic,  which  were  concealed  from  our 
physicians.  I  am  not  singular  in  ascribing  the 
death  of  convalescents  to  the  too  early  use  of  ani- 
mal food.     Dr.  Poissonnier  has  the  following  im- 


46  AN    ACCOUNT    OF    THE 

portant  remark  upon  this  subject.  "  The  physi- 
cians of  Brest  have  observed,  that  the  relapses  in 
the  malignant  fever,  which  prevailed  in  their  naval 
hospitals,  were  as  much  the  effect  of  a  fault  in  the 
diet  of  the  sick  as  of  the  contagious  air  to  which 
they  were  exposed,  and  that  as  many  patients  pe- 
rished from  this  cause  as  from  the  original  fever. 
For  this  reason  light  soups,  with  leguminous  vege- 
tables in  them,  panada,  rice  seasoned  with  cinna- 
mon, fresh  eggs,  &x.  are  all  that  they  should  be 
permitted  to  eat.  The  use  of  flesh  should  be  for- 
bidden for  many  days  after  the  entire  cure  of  the 
disorder*." 

Dr.  Huxham  has  furnished  another  evidence  of 
the  danger  from  the  premature  use  of  animal  food, 
in  his  history  of  a  malignant  fever  which  prevailed 
at  Plymouth,  in  the  year  1740.  "  If  any  one  (says 
the  doctor)  made  use  of  a  flesh  or  fish  diet,  be- 
fore he  had  been  very  well  purged,  and  his  recovery 
confirmed,  he  infallibly  indulged  himself  herein  at 
the  utmost  danger  of  his  lifef." 

* 

In  addition  to  the  mild  articles  of  diet,  mention- 
ed by  Dr.  Poissonnier,  I  found  bread  and  milk, 

*  Maladies  de  Gens  de  Mer,  vol.  i.  p.  345. 
t  Epidemics,  vol.  ii.  p.  67. 


BILIOUS    YELLOW    FEVER    OF     1797.  47 

with  a  little  water,  sugar,  and  the  pulp  of  a  roasted 
apple  mixed  with  it,  very  acceptable  to  my  patients 
during  their  convalescence.  Oysters  were  equally 
innocent  and  agreeable.  Ripe  grapes  were  de- 
voured by  them  with  avidity,  in  every  stage  of  the 
fever.  The  season  had  been  favourable  to  the  per- 
fection of  this  pleasant  fruit,  and  all  the  gardens  in 
the  city  and  neighbourhood  in  which  it  was  culti- 
vated were  gratuitously  opened  by  the  citizens  for 
the  benefit  of  the  sick. 

The  drinks  were,  cold  water,  toast  and  water, 
balm  tea,  water  in  which  jellies  of  different  kinds 
had  been  dissolved,  lemonade,  apple  water,  barley 
and  rice  water,  and,  in  cases  where  the  stomach 
was  affected  with  sickness  or  puking,  weak  porter 
and  water,  and  cold  camomile  tea.  In  the  conva- 
lescent stage  of  the  fever,  and  in  such  of  its  remis- 
sions or  intermissions  as  were  accompanied  with 
great  languor  in  the  pulse,  wine- whey,  porter  and 
water,  and  brandy  and  water,  were  taken  with  ad- 
vantage. 

Cold  water  applied  to  the  body,  cool  and  fresh 
air,  and  cleanliness,  produced  their  usual  good  ef- 
fects in  this  fever.  In  the  external  use  of  cold  wa- 
ter, care  was  taken  to  confine  it  to  such  cases  as 
were  accompanied  with  preternatural  heat,  and  to 


48  AN    ACCOUNT    OF    THE 

forbid  it  in  the  cold  fit  of  the  fever,  and  in  those 
cases  which  were  attended  with  cold  hands  and  feet, 
and  where  the  disease  showed  a  disposition  to  ter- 
minate, in  its  first  stage,  by  a  profuse  perspiration. 
It  has  lately  given  me  great  pleasure  to  find  the 
same  practice,  in  the  external  use  of  cold  water  in 
fevers,  recommended  by  Dr.  Currie  of  Liverpool, 
in  his  medical  reports  of  the  effects  of  water,  cold 
and  warm,  as  a  remedy  in  febrile  diseases.  Of  the 
benefit  of  fresh  air  in  this  fever,  Dr.  Dawson  of 
Tortola  has  lately  furnished  me  with  a  striking  in- 
stance. He  informed  me,  that  by  removing  pa- 
tients from  the  low  grounds  on  that  island,  where 
the  fever  is  generated,  to  a  neighbouring  mountain, 
they  generally  recovered  in  a  few  days. 

Finding  a  disagreeable  smell  to  arise  from  vine- 
gar  sprinkled  upon  the  floor,  after  it  had  emitted  all 
its  acid  vapour,  I  directed  the  floors  of  sick  rooms 
to  be  sprinkled  only  with  water.  I  found  the  va- 
pour which  arose  from  it  to  be  grateful  to  my 
patients.  A  citizen  of  Philadelphia,  whose  whole 
family  recovered  from  the  fever,  thought  he  per- 
ceived evident  advantages  from  tubs  of  fresh  water 
being  kept  constantly  in  the  sick  rooms. 


BILIOUS    YELLOW    FEVER    OF    1797.  49 

OF  TONIC  REMEDIES. 

There  were  now  and  then  remissions  and  inter- 
missions of  the  fever,  accompanied  with  such  signs 
of  danger  from  debility,  as  to  render  the  exhibition 
of  a  few  drops  of  laudanum,  a  little  wine- whey,  a 
glass  of  brandy  and  water,  and,  in  some  instances, 
a  cup  of  weak  chicken- broth,  highly  necessary  and 
useful.  In  addition  to  these  cordial  drinks,  I  di- 
rected the  feet  to  be  placed  in  a  tub  of  warm  water, 
which  was  introduced  under  the  bed-clothes,  so 
that  the  patient  was  not  weakened  by  being  raised 
from  a  horizontal  posture.  All  these  remedies 
were  laid  aside  upon  the  return  of  a  paroxysm  of 
fever. 

I  did  not  prescribe  bark  in  a  single  case  of  this 
disease.  An  infusion  of  the  quassia  root  was  sub- 
stituted in  its  room,  in  several  instances,  with  ad- 
vantage. 

Blisters  were  applied  as  usual,  but,  from  the 
insensibility  of  the  skin,  they  were  less  effectual 
than  applications  of  mustard  to  the  arms  and  legs. 
It  is  a  circumstance  worthy  of  notice,  that  while 
the  stomach,  bowels,  and  even  the  large  blood- 
vessels are  sometimes  in  a  highly  excited  state,  and 

VOL.   IV.  G 


50  AN    ACCOUNT    OF    THE 

overcharged,  as  it  were,  with  life,  the  whole  sur- 
face of  the  body  is  in  a  state  of  the  greatest  torpor. 
To  attempt  to  excite  it  by  internal  remedies  is  like 
adding  fuel  to  a  chimney  already  on  fire.  The  ex- 
citement of  the  blood-vessels,  and  the  circulation 
of  the  blood,  can  only  be  equalized  by  the  applica- 
tion of  stimulants  to  the  skin.  These,  to  be  effec- 
tual, should  be  of  the  most  powerful  kind.  Caus- 
tics might  probably  be  used  in  such  cases  with 
advantage.  I  am  led  to  this  opinion  by  a  fact  com- 
municated to  me  by  Dr.  Stewart.  A  lighted  can- 
dle, which  had  been  left  on  the  bed  of  a  woman 
whom  he  was  attending  in  the  apparent  last  stage 
of  the  yellow  fever,  fell  upon  her  breast.  She  was 
too  insensible  to  feel,  or  too  weak  to  remove  it. 
Before  her  nurse  came  into  her  room,  it  had  made 
a  deep  and  extensive  impression  upon  her  flesh. 
From  that  time  she  revived,  and  in  the  course  of  a 
few  days  recovered.  As  a  tonic  remedy  in  this 
fever,  Dr.  Jackson  has  spoken  to  me  in  high  terms 
of  the  good  effects  of  riding  in  a  carriage.  Patients, 
he  informed  me,  who  were  moved  with  difficulty, 
after  riding  a  few  miles  were  able  to  sit  up,  and, 
when  they  returned  from  their  excursions,  were 
frequently  able  to  walk  to  their  beds. 

Much  has  been  said,  of  late  years,  in  favour  of 
the  application  of  warm  olive  oil  to  the  body  in  the 


BILIOUS    YELLOW    FEVER    OF    1797.  51 

plague,  and  a  wish  has  been  expressed,  by  some 
people,  that  its  efficacy  might  be  tried  in  the  yellow 
fever.  Upon  examining  the  account  of  this  re- 
medy, as  published  by  Mr.  Baldwin,  three  things 
suggest  themselves  to  our  notice.  1.  That  the  oil 
is  effectual  only  in  the  forming  state  of  the  disease; 

2.  That  the  friction  which  is  used  with  it  contri- 
butes to  excite  the  torpid  vessels  of  the  skin  ;  and 

3.  That  it  acts  chiefly  by  depleting  from  the  pores 
of  the  body.  From  the  unity  of  the  remedy  of 
depletion,  it  is  probable  purging  or  bleeding  might 
be  substituted  to  the  expensive  parade  of  the  sweat 
induced  by  the  warm  oil,  and  the  smoke  of  odori- 
ferous vegetables.  But  I  must  not  conceal  here, 
that  there  are  facts  which  favour  an  idea,  that  oil 
produces  a  sedative  action  upon  the  blood-vessels, 
through  the  medium  of  the  skin.  Bontius  says  it 
is  used  in  this  manner  in  the  East-Indies,  for  the 
cure  of  malignant  fevers,  after  the  previous  use  of 
bleeding  and  purging.  It  seems  to  have  been  a 
remedy  well  known  among  the  Jews ;  hence  we 
find  the  apostle  James  advises  its  being  applied  to 
the  body,  in  addition  to  the  prayers  of  the  elders 
of  the  church*.  It  is  thus  in  other  cases,  the 
blessings  of  Heaven  are  conveyed  to  men  through 
the  use  of  natural  means. 

*  Chapter  v.  verse  14. 


52  AN    ACCOUNT    OF    THE 

During  the  existence  of  the  premonitory  symp- 
toms, and  before  patients  were  confined  to  their 
rooms,  a  gentle  purge,  or  the  loss  of  a  few  ounces 
of  blood,  in  many  hundred  instances,  prevented  the 
formation  of  the  fever.  I  did  not  meet  with  a  sin- 
gle exception  to  this  remark. 

Fevers  are  the  affliction  chiefly  of  poor  people. 
To  prevent  or  to  cure  them,  remedies  must  be 
cheap,  and  capable  of  being  applied  with  but  little 
attendance.  From  the  affinity  established  by  the 
Creator  between  evil  and  its  antidotes,  in  other  parts 
of  his  works,  I  am  disposed  to  believe  no  remedy 
will  ever  be  effectual  in  any  general  disease,  that  is 
not  cheap,  and  that  cannot  easily  be  made  universal. 

It  is  to  be  lamented  that  the  greatest  part  of  all 
the  deaths  which  occur,  are  from  diseases  that  are 
under  the  power  of  medicine.  To  prevent  their 
fatal  issue,  it  would  seem  to  be  agreeable  to  the 
order  of  Heaven  in  other  things,  that  they  should 
be  attacked  in  their  forming  state.  Weeds,  ver- 
min, public  oppression,  and  private  vice,  are  easily 
eradicated  and  destroyed,  if  opposed  by  their  pro- 
per remedies,  as  soon  as  they  show  themselves. 
The  principal  obstacle  to  the  successful  use  of  the 
antidotes  of  malignant  fevers,  in  their  early  stage, 
arises  from  physicians  refusing  to  declare  when 


BILIOUS    YELLOW    FEVER    OF    1797.  53 

they  appear  in  a  city,  and  from  their  practice  of 
calling  their  mild  forms  by  other  names  than  that  of 
a  mortal  epidemic. 

I  shall  now  say  a  few  words  upon  the  success  of 
the  depleting  practice  in  this  epidemic. 

From  the  more  malignant  state  of  the  fever,  and 
from  the  fears  and  prejudices  that  were  excited 
against  bleeding  and  mercury  by  means  of  the  news- 
papers, the  success  of  those  remedies  was  much 
less  than  in  the  years  1793  and  1794.  Hundreds 
refused  to  submit  to  them  at  the  ti?ney  and  in  the 
manner ',  that  were  necessary  to  render  them  effec- 
tual. From  the  publications  of  a  number  of  physi- 
cians, who  used  the  lancet  and  mercury  in  their 
greatest  extent,  it  appears  that  they  lost  but  one  in 
ten  of  all  they  attended.  It  was  said  of  several 
practitioners  who  were  opposed  to  copious  bleed- 
ing, that  they  lost  a  much  smaller  proportion  of  their 
patients  with  the  prevailing  fever.  Upon  inquiry, 
it  appeared  they  had  lost  many  more.  To  conceal 
their  want  of  success,  they  said  their  patients  had 
died  of  other  diseases.     This  mode  of  deceiving 

o 

the  public  began  in  1793.  The  men  who  used  it 
did  not  recollect,  that  it  is  less  in  favour  of  a  phy- 
sician's skill  to  lose  patients  in  pleurisies,  colics, 


54  AN    ACCOUNT    OF    THE 

haemorrhages,  contusions,  and  common  remittents, 
than  in  a  malignant  yellow  fever. 

Dr.  Sayre  attended  fifteen  patients  in  the  disease, 
all  of  whom  recovered  by  the  plentiful  use  of  the 
depleting  remedies.  His  place  of  residence  being 
remote  from  those  parts  of  the  city  in  which  the 
fever  prevailed  most,  prevented  his  being  called  to 
a  greater  number  of  cases. 

A  French  physician,  who  bled  and  purged  mode- 
rately, candidly  acknowledged  that  he  saved  but 
three  out  of  four  of  his  patients. 

In  the  city  hospital,  where  bleeding  was  sparing- 
ly used,  and  where  the  physicians  depended  chiefly 
upon  a  salivation,  more  than  one  half  died  of  all 
the  patients  who  were  admitted.  It  is  an  act  of 
justice  to  the  physicians  of  the  hospital  to  add,  that 
many,  perhaps  most  of  their  patients,  were  admitted 
after  the  first  day  of  the  disease. 

I  cannot  conclude  this  comparative  view  of  the 
success  of  the  different  modes  of  treating  the  yellow 
fever,  without  taking  notice,  that  the  stimulating 
mode,  as  recommended  bv  Dr.  Kuhn  and  Dr. 
Stevens,  in  the  year  1793,  was  deserted  by  every 
physician  in  the  city.     Dr.  Stevens  acknowledged 


BILIOUS    YELLOW    FEVER    OF    1797.  55 

the  disease  to  require  a  different  treatment  from 
that  which  it  required  in  the  West- Indies ;  Dr. 
Kuhn  adopted  the  lancet  and  mercury  in  his  prac- 
tice ;  and  several  other  physicians,  who  had  written 
against  those  remedies,  or  who  had  doubted  of  their 
safety  and  efficacy,  in  1793,  used  them  with  confi- 
dence, and  in  the  most  liberal  manner,  in  1797. 

In  the  histories  I  have  given  of  the  yellow  fevers 
of  1793  and  1794,  I  have  scattered  here  and  there  a 
few  observations  upon  their  degrees  of  danger,  and 
the  signs  of  their  favourable  or  unfavourable  issue. 
I  shall  close  the  present  history,  by  collecting  those 
observations  into  one  view,  and  adding  to  them 
such  other  signs  as  have  occurred  to  me  in  observ- 
ing this  epidemic. 

Signs  of  moderate  danger,  and  a  favourable  issue 
of  the  yellow  fever. 

1.  A  chilly  fit  accompanying  the  attack  of  the 
fever.  The  longer  this  chill  continues,  the  more 
favourable  the  disease. 

2.  The  recurrence  of  chills  every  day,  or  twice 
a  day,  or  every  other  day,  with  the  return  of  the 
exacerbations  of  the  fever.  A  coldness  of  the 
whole  body,  at  the  above  periods,  without  chilis,  a 


56  AN    ACCOUNT    OF    THE 

coldness  with  a  profuse  sweat,  cold  feet  and  hands, 
with  febrile  heat  in  other  parts  of  the  body,  and  a 
profuse  sweat  without  chills  or  coldness,  are  all  less 
favourable  symptoms  than  a  regular  chilly  fit,  but 
they  indicate  less  danger  than  their  total  absence 
during  the  course  of  the  fever. 

3.  A  puking  of  green  or  yellow  bile  on  the  first 
day  of  the  disease  is  favourable.  A  discharge  of 
black  bile,  if  it  occur  on  the  Jirst  day  of  the  fever, 
is  not  unfavourable. 

4.  A  discharge  of  green  and  yellow  stools.  It 
is  more  favourable  if  the  stools  are  of  a  dark  or 
black  colour,  and  of  a  foetid  and  acrid  nature,  on 
the  first  or  second  day  of  the  fever. 

5.  A  softness  and  moisture  on  the  skin  in  the 
beginning  of  the  fever. 

6.  A  sense  of  pain  in  the  head,  or  a  sudden 
translation  of  pain  from  internal  to  external  parts  of 
the  body,  particularly  to  the  back.  An  increase 
of  pain  after  bleeding. 

7.  A  sore  mouth. 

8.  A  moist  white,  or  a  yellow  tongue- 


.     BILIOUS    YELLOW    FEVER    OF    1797.  57 

9.  An  early  disposition  to  spit  freely,  whether 
excited  by  nature  or  the  use  of  mercury. 


10.  Blood  becoming  sizy,  after  having  exhibited 

S  USU2 

vessels. 


the  usual  marks  of  great  morbid  action  in  the  blood- 


11.  Great  and  exquisite  sensibility  in  the  sense 
of  feeling  coming  on  near  the  close  of  the  fever. 

12.  Acute  pains  in  the  back  and  limbs. 

13.  The  appearance  of  an  inflammatory  spot  on  a 
finger  or  toe,  Dr.  H.  M'Clen  says,  is  favourable. 
It  appears,  the  doctor  says,  as  if  the  cause  of  the 
fever  had  escaped  by  explosion. 

Signs  of  great  danger,  and  of  an  unfavourable 
issue  of  the  yellow  fever  are, 

1.  An  attack  of  the  fever,  suddenly  succeeding 
great  terror,  anger,  or  the  intemperate  use  of  ve- 
nery,  or  strong  drink. 

2.  The  first  paroxysm  coming  on  without  any 
premonitory  symptoms,  or  a  chilly  fit. 

VOL.  IV.  H 


58  AN    ACCOUNT    OF    THE 

3.  A  coldness  over  the  whole  body  without  chills 
for  two  or  three  days. 

4.  A  sleepiness  on  the  first  and  second  days  of 
the  fever. 

5.  Uncommon  paleness  of  the  face  not  induced 
by  blood-letting. 

6.  Constant  or  violent  vomiting,  without  any 
discharge  of  bile. 

7.  Obstinate  costiveness,  or  a  discharge  of  natu- 
ral, or  white  stools  ;  also  quick,  watery  stools  after 
taking  drink. 

8.  A  diarrhoea  towards  the  close  of  the  fever. 
I  lost  two  patients,  in  1797,  with  this  symptom, 
who  had  exhibited,  a  few  days  before,  signs  of  a 
recovery.  Dr.  Pinckard  informed  me,  that  it  was 
generally  attended  with  a  fatal  issue  in  the  yellow 
fever  of  the  West-Indies.  Diemerbroeck  declares, 
that  "  scarcely  one  in  a  hundred  recovered,  with 
this  symptom,  from  the  plague*.' ' 

9.  A  suppression  of  urine.  It  is  most  alarming 
when  it  is  without  pain. 

*  Lib.  i.  cap.  15. 


i 


BILIOUS    YELLOW    FEVER    OF    1797.  59 

10.  A  discharge  of  dark-coloured  and  bloody 
urine. 

11.  A  cold,  cool,  dry,  smooth,  or  shining  skin. 

12.  The  appearance  of  a  yellow  colour  in  the 
face  on  the  first  or  second  day  of  the  fever. 

13.  The  absence  of  pain,  or  a  sudden  cessation 
of  it,  with  the  common  symptoms  of  great  danger. 

14.  A  disposition  to  faint  upon  a  little  motion, 
and  fainting  after  losing  but  a  few  ounces  of  blood. 

15.  A  watery,  glassy,  or  brilliant  eye.  A  red 
eye  on  the  fourth  or  fifth  day  of  the  disease.  It  is 
more  alarming  if  it  become  so  after  having  been 
previously  yellow. 

16.  Imperfect  vision,  and  blindness  in  the  close 
of  the  disease. 

17.  Deafness. 

18.  A  preternatural  appetite,  more  especially  in 
the  last  stage  of  the  fever. 

19.  A  slow,  intermitting,  and  shattered  pulse. 


60  AN    ACCOUNT    OF    THE 

20.  Great  restlessness,  delirium,  and  long  conti- 
nued coma. 

21.  A  discharge  of  coffee- coloured  or  black 
matter  from  the  stomach,  after  the  fourth  day  of 
the  fever. 

*•» 

22.  A  smooth  red  tongue,  covered  with  a  lead- 
coloured  crust,  while  its  edges  are  of  a  bright  red. 

23.  A  dull  vacant  face,  expressive  of  distress. 

24.  Great  insensibility  to  common  occurrences, 
and  an  indifference  about  the  issue  of  the  disease. 

25.  Uncommon  serenity  of  mind,  accompanied 
with  an  unusually  placid  countenance. 

I  shall  conclude  this  head  by  the  following  re- 
marks : 

1.  The  violence,  danger,  and  probable  issue  of 
this  fever,  seem  to  be  in  proportion  to  the  duration 
and  force  of  the  predisposing  and  exciting  causes. 
However  steady  the  former  are  in  bringing  on  de- 
bility, and  the  latter  in  acting  as  irritants  upon  ac- 
cumulated excitability,  yet  a  knowledge  of  their 
duration  and  force  is  always  useful,  not  only  in 


BILIOUS    YELLOW    FEVER    OF    1797.         61 

forming  an  opinion  of  the  probable  issue  of  the  fe- 
ver, but  in  regulating  the  force  of  remedies. 

2.  The  signs  of  danger  vary  in  different  years, 
from  the  influence  of  the  weather  upon  the  disease. 

3.  Notwithstanding  the  signs  of  the  favourable 
and  unfavourable  issue  of  the  fever  are  in  general 
uniform,  when  the  cure  of  the  disease  is  committed 
to  nature,  or  to  tonic  medicines,  yet  they  are  far 
from  being  so  when  the  treatment  of  the  fever  is 
taken  out  of  the  hands  of  nature,  and  attempted 
by  the  use  of  depleting  remedies.  We  often  see 
patients  recover  with  nearly  all  the  unfavourable 
symptoms  that  have  been  mentioned,  and  we  some- 
times see  them  die,  with  all  those  that  are  favoura- 
ble. The  words  of  Morellus,  therefore,  which  he 
has  applied  to  the  plague,  are  equally  true  when 
applied  to  the  yellow  fever.  *?  In  the  plague,  our 
senses  deceive  us.  Reason  deceives  us.  The 
aphorisms  of  Hippocrates  deceive  us*."  An  im- 
portant lesson  may  be  learned  from  these  facts,  and 
that  is,  never  to  give  a  patient  over.  On  the  con- 
trary, it  is  our  duty  in  this,  as  well  as  in  all  other 
acute  diseases,  to  dispute  every  inch  of  ground  with 

*  De  Feb.  Pestilent,  cap.  v.     "  Acutorum  morborum  in- 
cests admodura,  ac  fallaces  sunt  pnedictiones." 

Hippocrates. 


62  AN    ACCOUNT,    &X. 

death.  By  means  of  this  practice,  which  is  war- 
ranted by  science,  as  well  as  dictated  by  humanity, 
the  grave  has  often  been  deprived  for  a  while  of  its 
prey,  and  a  prelude  thereby  exhibited  of  that  ap- 
proaching and  delightful  time  foretold  by  ancient 
prophets,  when  the  power  of  medicine  over  dis- 
eases shall  be  such,  as  to  render  old  age  the  only 
outlet  of  human  life. 


AN  ACCOUNT 


OF    THE 


BILIOUS  TELLOW  FEVER, 


AS    IT 


APPEARED  IN  PHILADELPHIA. 

IN  THE  YEAR    1798. 


AN  ACCOUNT,  &c 


THE  yellow  fever  of  the  year  1797  was 
succeeded  by  scarlatina,  catarrhs,  and  bilious  pleu- 
risies, in  the  months  of  November  and  December 
of  the  same  year.  The  weather  favoured  the  gene- 
ration of  the  latter  diseases.  It  became  suddenly 
cold  about  the  middle  of  November.  On  the  5th 
of  December,  the  navigation  of  the  Delaware  was 
obstructed.  There  was  a  thaw  on  the  13th  and 
14th  of  this  month,  but  not  sufficient  to  open  the 
river. 

In  the  month  of  January,  1798,  the  fevers  disco- 
vered an  uncommon  determination  to  the  brain. 
Four  cases  of  the  hydrocephalic  state  of  fever  oc- 
curred under  my  care  during  this  month,  all  of 
which  yielded  to  depleting  remedies.  The  sub- 
jects of  this  state  of  fever  were  Mr.  Robert  Lewis, 

VOL.  IV*  I 


66  AN    ACCOUNT    OF    THE 

and  the  daughters  of  Messrs.  John  Brooks,  Andrew 
Ellicott,  and  David  Maffat. 

The  weather  was  variable  during  the  months  of 
February  and  March.  The  navigation  of  the  De- 
laware was  not  completely  opened  until  the  latter 
end  of  February.  The  diseases  of  these  two 
months  were  catarrhs  and  bilious  pleurisies.  The 
former  were  confined  chiefly  to  children,  and  were 
cured  by  gentle  pukes,  purges  of  calomel,  and 
blood-letting.  The  last  remedy  was  employed 
twice  in  a  child  of  Isaac  Pisso,  of  six  weeks  old, 
and  once  in  a  child  of  Thomas  Billington,  of  three 
weeks  old,  with  success. 

On  the  7th  of  April,  I  visited  Mr.  Pollock,  lately 
from  the  state  of  Georgia,  in  consultation  with  Dr. 
Physick,  in  a  yellow  fever.  He  died  the  evening 
after  I  saw  him,  on  the  third  day  of  his  disease. 

There  was  a  snow  storm  on  the  16th  of  April, 
and  the  weather  was  afterwards  very  cold.  Such 
leaves  and  blossoms  as  had  appeared,  were  injured 
by  it. 

On  the  1st  of  May,  the  mercury  in  Fahrenheit's 
thermometer  rose  to  84°.  The  weather,  during 
the  latter  part  of  this  month,  and  in  June,  was  very 


BILIOUS    YELLOW    FEVER    OF    1798.  67 

dry.  On  the  6th  of  June,  Dr.  Cooper  lost  a  patient 
in  the  yellow  fever,  near  the  corner  of  Twelfth  and 
Walnut- streets.  Mark  Miller  died  with  the  same 
state  of  fever  on  the  2d  of  July.  About  a  dozen 
cases  of  a  similar  nature  occurred,  under  the  care 
of  different  practitioners,  between  the  2d  and  20th 
of  this  month,  and  all  of  them  in  parts  of  the  city 
remote  from  Water-street. 

On  the  19th  of  July,  the  weather  was  so  cool  as 
to  render  winter  clothes  comfortable.  A  severe 
hail  storm  had  occurred,  a  few  days  before,  in  the 
neighbourhood  of  Wilmington,  in  the  Delaware 
state. 

On  the  21st  of  the  month,  the  ship  Deborah  ar- 
rived from  one  of  the  West- India  islands,  and  dis- 
charged her  cargo  in  the  city.  She  was  moored 
afterwards  at  Kensington,  where  the  foul  air  which 
was  emitted  from  her  hold  produced  several  cases 
of  yellow  fever,  near  the  shores  of  that  village. 

In  August  the  disease  appeared  in  nearly  every 
part  of  the  city,  and  particularly  in  places  where 
there  was  the  greatest  exhalation  from  foul  gutters 
and  common  sewers. 


68  AN     ACCOUNT    OF    THE 

In  describing  the  disease,  as  it  appeared  this 
year,  I  shall  take  notice  of  its  symptoms  as  they 
appeared  in  the  blood-vessels,  alimentary  canal,  the 
tongue,  the  nervous  system,  in  the  eyes,  the 
lymphatic  system,  and  the  blood. 

The  subjects  which  furnished  the  materials  for 
this  history  were  not  only  private  patients,  but  the 
poor  in  the  city  hospital,  who  were  committed  to 
the  care  of  Dr.  Physick  and  myself,  by  the  board 
of  health. 

I.  The  pulse  wTas,  in  many  cases,  less  active 
in  the  beginning  of  this  fever  than  in  former  years. 
It  was  seldom  preternaturally  slow.  It  resembled 
the  pulse  which  occurs  in  the  first  stage  of  the 
common  jail  fever.  Haemorrhages  were  common 
about  the  fourth  and  fifth  days,  and  generally  from 
the  gums,  throat,  or  stomach. 

II.  The  whole  alimentary  canal  was  much  affect- 
ed in  most  cases.  Costiveness  and  a  vomiting 
were  general.  The  alvine  discharges  were  occa- 
sionally green,  dark- coloured,  black,  and  natural. 
The  black  vomiting  was  more  common  this  year 
than  in  former  years,  in  all  the  forms  of  die  fever. 
It  was  sometimes  suspended  for  several  days  before 
death,  and  hopes  were  entertained  of  a  recovery  of 


BILIOUS    YELLOW    FEVER    OF     1798,  69 

patients  in  whom  it  had  appeared.  In  a  boy,  at 
the  city  hospital,  it  ceased  ten  days  before  he  died. 
It  was  sometimes  succeeded  by  delirium  or  coma, 
but  it  more  commonly  left  the  patient  free  of  pain, 
and  in  the  possession  of  all  the  faculties  of  his  mind. 

III.  The  tongue  was  by  no  means  an  index  of 
the  state  of  the  fever,  as  in  the  years  1793  and  1797. 
I  saw  several  deaths,  attended  with  a  black  vomit- 
ing, in  which  the  tongue  retained  a  natural  appear- 
ance. This  phenomenon  at  first  deceived  me.  I 
ascribed  it  to  such  a  concentration  of  the  disease  in 
the  stomach  and  other  vital  parts,  as  to  prevent  its 
diffusing  itself  through  the  external  parts  of  the 
system.  We  observe  the  effects  of  the  same  cause 
in  a  natural  state  of  the  skin,  and  in  a  natural  ap- 
pearance of  the  urine,  in  the  most  malignant  forms 
of  this  fever. 

IV.  In  the  nervous  system,  the  disease  appeared 
with  several  new  symptoms.  A  relation  of  Peter 
Field  attempted  to  bite  his  attendants  in  the  deliri- 
um of  his  fever,  just  before  he  died. 

I  attended  a  young  woman  at  Mrs.  Easby's,  who 
started  every  time  I  touched  her  pulse.  Loud 
talking,  or  a  question  suddenly  proposed  to  her, 
produced  the  same  convulsive  motion.    She  retain- 


70  AN    ACCOUNT    ©F    THE 

ed  her  reason  during  the  whole  of  her  illness,  and 
was  cured  by  bleeding  and  a  salivation. 

Hiccup  was  a  common  symptom.  I  saw  but 
two  patients  recover  who  had  it.  In  one  of  them, 
Dr.  Hedges,  it  came  on  after  the  sixth  day  of  the 
fever,  and  continued,  without  any  other  symptom 
of  disease,  for  four  or  five  days. 

I  lost  a  patient  who  complained  of  no  pain  but 
in  the  calves  of  his  legs.  Dr.  Physick  lost  a  girl, 
in  the  city  hospital,  who  complained  only  of  pains 
in  her  toes.  Her  stomach  discovered,  after  death* 
strong  marks  of  inflammation. 

Many  people  passed  through  every  stage  of  the 
disease,  without  uttering  a  complaint  of  pain  of  any 
kind. 

An  uncommon  stiffness  in  the  limbs  preceded 
death  a  few  hours,  in  several  cases.  This  stiffness 
ceased,  in  one  of  Dr.  Physick 's  patients,  immedi- 
ately after  death,  but  returned  as  soon  as  he  became 
cold. 

An  obstinate  wakefulness  continued  through  the 
whole  of  the  disease  in  Dr.  Leib.  It  was  common 
during  the  convalescence,  in  many  cases. 


BILIOUS    YELLOW    FEVER    OF    1798.  71 

The  whole  body  was  affected,  in  many  cases, 
with  a  morbid  sensibility,  or  what  has  been  called 
supersensation,  so  that  patients  complained  of  pain 
upon  being  touched,  when  they  were  moved  in 
their  beds.  This  extreme  sensibility  was  general 
in  parts  to  which  blisters  had  been  applied.  It 
continued  through  every  stage  of  the  disease.  Dr. 
Physick  informed  me,  that  he  observed  it  in  a 
man  two  hours  before  he  died.  In  this  man  there 
was  an  absence  of  pulse,  and  a  coldness  of  his  ex- 
tremities. Upon  touching  his  wrist,  he  cried  out, 
as  if  he  felt  great  pain. 

V.  A  redness  in  the  eyes  was  a  general  symp- 
tom. I  saw  few  recoveries  where  this  redness  was 
not  removed. 

A  discharge  of  matter  from  one  ear  relieved  Mr. 
J.  C.  Warren  from  a  distressing  pulsation  of  the 
arteries  in  his  head. 

VI.  Glandular  swellings  occurred  in  several  in- 
stances. Two  cases  of  them  came  under  my  no- 
tice.    They  both  terminated  favourably. 

VII.  The  blood  had  its  usual  appearances  in  this 
disease.     In  the  yellow  fever  which  prevailed  at 


72  AN    ACCOUNT    OF    THE 

the  same  time  in  Boston,  Dr.  Rand  says  the  blood 
was  sizy  in  but  one  out  of  a  hundred  cases. 

The  forms  of  the  fever  were  nearly  similar  to 
those  which  have  been  described  in  the  year  1797. 
I  saw  several  cases  in  which  the  disease  appeared 
in  the  form  of  a  tertian  fever.  In  one  of  them  it 
terminated  in  death. 

The  system,  in  many  cases,  was  prostrated  be- 
low  the  point  of  inflammatory  re- action.  These 
were  called,  by  some  practitioners,  typhous  fevers. 
It  was  the  most  dangerous  and  fatal  form  of  the 
disease.  Its  frequent  occurrence  gave  occasion  to 
a  remark,  that  our  epidemic  resembled  the  yellow 
fever  of  the  West- Indies,  much  more  than  the  fe- 
vers of  1793  and  1797. 

I  attended  two  patients  in  whom  the  disease  was 
protracted  nearly  to  the  30th  day.  They  both  re- 
covered. 

Dr.  Francis  Sayre  informed  me,  that  he  saw  a 
child,  in  which  the  morbid  affection  of  the  wind- 
pipe, called  cynanche  trachealis,  appeared  with  all 
the  usual  symptoms  of  yellow  fever* 


BILIOUS    YELLOW    FEVER    OF    1798.  73 

I  attended  one  case  in  which  the  force  of  the 
disease  was  weakened,  in  its  first  stage,  by  a  pro- 
fuse haemorrhage  from  the  bowels.  This  haemor- 
rhage was  followed  by  a  bloody  diarrhoea,  which 
continued  for  four  or  five  weeks. 

Persons  of  all  ages  and  colours  were  affected  by 
this  fever.  I  saw  a  case  of  it  in  a  child  of  six 
months  old.  In  the  blacks,  it  was  attended  with  less 
violence  and  mortality  than  in  white  people.  It 
affected  many  persons  who  had  previously  had  it. 

The  disease  was  excited  by  the  same  causes 
which  excited  it  in  former  years.  I  observed  a 
number  of  people  to  be  affected  by  the  fever,  who 
lived  in  solitude  in  their  houses,  without  doing  any 
business.  The  system,  in  these  persons,  was  pre- 
disposed to  the  disease,  by  the  debility  induced  by 
ceasing  to  labour  at  their  former  occupations.  It 
was  excited  in  a  young  man  by  a  fractured  leg. 
He  died  five  days  afterwards,  with  a  black  vomit- 
ing. I  observed,  in  several  instances,  an  interval 
of  four  and  five  days  betweeivthe  debility  induced 
upon  the  system  by  a  predisposing,  and  the  action 
of  an  exciting  cause.  Dr.  Clark  says,  he  has  seen 
an  interval  of  several  weeks  between  the  operation 
of  those  causes,  in  the  yellow  fever  of  Dominique. 

VOL.   IV.  K 


AN    ACCOUNT    OF    THE 


These  facts  are  worthy  of  notice,  as  they  lead  to  a 
protracted  use  of  the  means  of  obviating  an  attack 
of  the  disease. 

During  my  attendance  upon  the  sick,  I  twice 
perceived  in  my  system  the  premonitory  signs  of 
the  epidemic.  Its  complete  formation  was  pre- 
vented each  time  by  rest,  a  moderate  dose  of  phy- 
sic, and  a  plentiful  sweat. 

I  shall  now  take  notice  of  the  different  manner  in 
which  patients  died  of  this  fever.  The  detail  may 
be  useful,  by  unfolding  new  principles  in  the  ani- 
mal economy,  as  well  as  new  facts  in  the  history  of 
the  disease. 

1.  The  disease  terminated  in  death,  in  some  in- 
stances, by  means  of  convulsions. 

2.  By  delirium,  which  prompted  to  exertions 
and  actions  similar  to  those  which  take  place  in 
madness. 

3.  By  profuse  haemorrhages  from  the  gums. 
This  occurred  in  two  patients  of  Dr.  Stewart. 

4.  By  an  incessant  vomiting  and  hiccup. 


BILIOUS    YELLOW    FEVER    OF    1798.  75 

5.  By  extreme  pain  in  the  calves  of  the  legs  and 
i   toes,  which,  by  destroying  the  excitement  of  the 

system,  destroyed  life. 

6.  By  a  total  absence  of  pain.  In  this  way  it 
put  an  end  to  the  life  of  Mr.  Henry  Hill. 

7.  By  a  disposition  to  easy,  and  apparently  na- 
tural sleep.  I  have  reason  to  believe  that  Mr.  Hill 
encouraged  this  disposition  to  sleep,  a  few  hours 
before  he  died,  under  the  influence  of  a  belief  that 
he  would  be  refreshed  by  it.  Diemerbroeck  says 
the  plague  often  killed  in  the  same  way. 

8.  The  mind  was  in  many  cases  torpid,  where 
no  delirium  attended,  and  death  was  submitted  to 
with  a  degree  of  insensibility,  which  was  often 
mistaken  for  fortitude  and  resignation. 

I  shall  now  mention  the  morbid  appearances  ex- 
hibited by  the  bodies  of  persons  who  died  of  this 
fever,  as  communicated  to  me  by  my  friend,  Dr. 
Physick;  being  the  result  of  numerous  dissections 
made  by  him  at  the  city  hospital. 

In  all  of  them  the  stomach  was  inflamed.  The 
matter  which  constitutes  what  is  called  ihe  black 
vomit,  was  found  in  the  stomachs  of  several  patients 


76  AN    ACCOUNT    OF    THE 

who  had  not  discharged  it  at  any  time  by  vomiting. 
In  some  stomachs,  he  found  lines  which  seemed 
to  separate  the  living  from  their  dead  parts.  Those 
parts,  though  dead,  were  not  always  in  a  mortified 
state.  They  were  distinguished  from  the  living 
parts  by  a  peculiar  paleness,  and  by  discovering  a 
weak  texture  upon  being  pressed  between  the  fin- 
gers. He  observed  the  greatest  marks  of  inflam- 
mation in  the  stomachs  of  several  persons  in  whom 
there  had  been  no  vomiting,  during  the  whole 
course  of  the  disease.  The  brain,  in  a  few  in- 
stances, discovered  marks  of  inflammation.  Water 
was  now  and  then  found  in  its  ventricles,  but  al- 
ways of  its  natural  colour,  even  in  those  persons 
whose  skins  were  yellow.  The  liver  suffered  but 
little  in  this  disease.  It  may  serve  to  increase  our 
knowledge  of  the  influence  of  local  circumstances 
upon  epidemics  to  remark,  that  this  viscus,  which 
was  rarely  diseased  in  the  fever  of  Philadelphia  in 
1798,  discovered  marks  of  great  inflammation  in 
the  bodies  which  were  examined  by  Dr.  Rand  and 
Dr.  Warren,  in  the  town  of  Boston,  where  the 
yellow  fever  prevailed  at  the  same  time  it  did  in 
Philadelphia. 

The  weather  was  hot  and  drv  in  August  and 
September,  during  the  prevalence  of  this  fever.  Its 
influence  upon  animal  and  vegetable  life  are  worthy 


BILIOUS    YELLOW    FEVER    OF    1798.  77 

of  notice.  Moschetoes  abounded,  as  usual  in  sickly 
seasons ;  grasshoppers  covered  die  ground  in  many 
places ;  cabbages  and  other  garden  vegetables,  and 
even  fields  of  clover,  were  devoured  by  them. 
Peaches  ripened  this  year  three  weeks  sooner  than 
in  ordinary  summers,  and  apples  rotted  much  soon- 
er than  usual  after  being  gathered  in  the  autumn. 
Many  fruit-trees  blossomed  in  October,  and  a  se- 
cond crop  of  small  apples  and  cherries  were  seen 
in  November,  on  the  west  side  of  Schuylkill,  near 
the  city.  Meteors  were  observed  in  several  places. 
On  the  29th  of  September  there  was  a  white  frost. 
Its  effects  upon  the  fever  were  obvious  and  general. 
It  declined,  in  every  part  of  the  city,  to  such  a  de- 
gree as  to  induce  many  people  to  return  from  the 
country.  In  the  beginning  of  October  the  weather 
again  became  warm,  and  the  disease  revived.  It 
was  observable,  that  all  great  changes  in  the  wea- 
ther from  heat  to  cold  that  were  short  of  frost,  or 
of  cold  to  heat,  increased  the  mortality  of  the  fever. 
It  spread  most  rapidly  in  moist  weather. 

The  origin  of  this  fever  was  from  the  exhalations 
of  gutters,  docks,  cellars,  common  sewers,  ponds 
of  stagnating  water,  and  from  the  foul  air  of  the 
ship  formerly  mentioned. 


78  AN    ACCOUNT    OF    THE 

The  fever  prevailed  at  the  same  time  in  the  town 
of  Chester,  in  Pennsylvania ;  in  Wilmington,  in 
the  state  of  Delaware ;  in  New- York  ;  in  New- 
London,  in  Connecticut;  in  Windsor,  in  Vermont; 
and  in  Boston ;  in  all  which  places  its  origin  was 
traced  to  domestic  sources. 

I  shall  now  deliver  a  short  account  of  the  reme- 
dies employed  in  the  cure  of  this  disease. 

I  have  said  that  the  pulse  wras  less  active  in  this 
fever  than  in  the  fevers  of  former  years.  It  was 
seldom,  however,  so  feeble  as  to  forbid  bleeding. 
In  Dr.  Mease  it  called  for  the  loss  of  162  ounces 
of  blood,  and  in  Mr.  J.  C.  Warren  for  the  loss  of 
200,  by  successive  bleedings,  before  it  was  sub- 
dued. But  such  cases  were  not  common.  In 
most  of  them,  the  pulse  flagged  after  two  or  three 
bleedings.  But  there  were  cases  in  which  the  lan- 
cet was  forbidden  altogether.  In  these,  the  sys- 
tem appeared  to  be  prostrated,  by  the  force  of  the 
miasmata,  below  the  point  of  re-action.  This  state 
of  the  disease  manifested  itself  in  a  wreak,  quick, 
and  frequent  pulse,  languid  eye,  sighing,  great  in- 
quietude, or  great  insensibility.  However  unsafe 
bleeding  was  on  the  first  day  of  this  fever,  when  it 
appeared  with  those  symptoms,  nature  often  per- 


BILIOUS    YELLOW    FEVER    OF    1798.  79 

formed  that  operation  upon  herself  from  the  gums, 
on  the  fourth  or  fifth  day.  I  saw  several  pounds 
of  blood  discharged  on  those  days,  and  in  that  way, 
with  the  happiest  effects.  It  appeared  to  take 
place  after  the  revival  of  the  blood-vessels  from 
their  prostrated  state. 

From  a  conviction  that  the  system  was  depressed 
only  in  these  cases,  and  finding  that  it  did  not 
rise  upon  blood-letting,  I  resolved  to  try  the  effects 
of  emetics,  in  exciting  and  equalizing  the  action  of 
the  blood-vessels.  The  experience  I  had  had  of 
the  inefficacy  of  this  remedy  in  1793,  and  of  its  ill 
effects  in  one  instance  in  1797,  led  me  to  exhibit 
it  with  a  trembling  hand.  I  gave  it  for  the  first 
time  to  a  son  of  Richard  Renshaw.  I  had  bled 
him  but  once,  and  had  in  vain  tried  to  bring  on  a 
salivation.  On  the  fifth  day  of  his  disease,  his 
pulse  became  languid  and  slow,  his  skin  cool,  a 
haemorrhage  had  taken  place  from  his  gums,  and 
he  discovered  a  restlessness  and  anxiety  which  I 
had  often  seen  a  few  hours  before  death.  He  took 
four  grains  of  tartar  emetic,  with  twenty  grains  of 
calomel,  at  two  doses.  They  operated  powerfully, 
upwards  and  downwards,  and  brought  away  a  large 
quantity  of  bile.  The  effects  of  this  medicine 
were  such  as  I  wished.  The  next  day  he  was  out 
of  danger.      I  prescribed  the  same  medicine  in 


80  AN   ACCOUNT   OF    THE 

man}'  other  cases  with  the  same  success.  To  se- 
veral of  my  patients  I  gave  two  emetics  in  the 
course  of  the  disease.  Some  of  them  discharged 
bile  resembling  in  viscidity  the  white  of  an  eg^. 
But  I  saw  one  case  in  which  great  relief  was  ob- 
tained from  the  operation  of  an  emetic,  where  no 
bile  was  discharged. 

In  the  exhibition  of  this  remedy,  I  was  regu- 
lated by  the  pulse.  If  I  found  it  languid  on  the 
first  day  of  the  fever,  I  gave  it  before  any  other 
medicine.  When  it  was  full  and  tense,  I  deferred 
it  until  I  had  reduced  the  pulse  to  the  emetic  point 
by  bleeding  and  purges.  I  observed,  with  great 
pleasure,  that  mercury  affected  the  mouth  more 
speedily  and  certainly  where  an  emetic  had  been 
administered,  than  in  other  cases,  probably  from 
awakening,  by  its  stimulus,  the  sensibility  of  the 
stomach  ;  for  such  was  its  torpor,  that  in  one  case 
ten  grains  of  tartar  emetic,  and  in  another  thirty 
grains,  did  not  operate  upon  it,  so  as  to  excite  even 
the  slightest  degree  of  nausea. 

In  many  cases,  an  emetic,  given  in  the  forming 
state  of  the  disease,  seemed  to  effect  an  immediate 
cure. 


EILIOUS    YELLOW    FEVER    OF    1798.  81 

Purges  produced  the  same  salutary  effects  that 
they  did  in  former  years.  I  always  combined  ca- 
lomel with  them  in  the  first  stage  of  the  disease. 

A  salivation  was  found  to  be  the  most  certain 
remedy  of  any  that  was  used  in  this  fever.  I  did 
not  lose  a  single  patient,  in  whom  the  mercury 
acted  upon  the  salivary  glands.  It  was  difficult  to 
excite  it  in  many  cases,  from  the  mercury  being 
rejected  by  the  stomach,  from  its  passing  off  by 
the  bowels,  or  from  its  stimulus  being  exceeded 
by  the  morbid  action  in  the  blood-vessels. 


Bleeding  rendered  the  action  of  the  mercury 
upon  the  mouth  more  speedy  and  more  certain, 
but  I  saw  several  cases  in  which  a  salivation  was 
excited  in  the  most  malignant  forms  of  the  fever, 
where  no  blood  had  been  drawn.  It  will  not  be 
difficult  to  explain  the  reason  of  this  fact  if  we  recur 
to  what  was  said  formerly  of  the  prostration  of  the 
system  in  this  fever.  In  its  worst  forms,  there  is 
-  often  a  total  absence,  or  a  feeble  degree  of  action 
in  the  blood-vessels,  from  an  excess  of  the  stimulus 
of  the  remote  cause  of  the  fever.  Here  the  mer- 
cury meets  with  no  resistance  in  its  tendency  to 
the  mouth.  Bleeding  in  this  case  would  probably 
do  harm,  by  taking  off  a  part  of  the  pressure  upon 
the  system,  and  thereby  produce  a  re-action  in  the 

VOL.    IV.  L 


82      *  AN    ACCOUNT    OF    THE 

vessels,  that  might  predominate  over  the  action  of 
the  mercury.  The  disease  here  does  that  for  us 
by  its  force,  which,  in  other  cases,  we  effect  by 
depleting  remedies. 

Where  the  mercury  showed  a  disposition  to  pass 
too  rapidly  through  the  bowels,  I  observed  no  in- 
convenience from  combining  it  with  opium,  in  my 
attempts  to  excite  a  salivation.  The  calomel  was 
constantly  aided  by  mercurial  ointment,  applied  by 
friction  to  different  parts  of  the  body. 

Now  and  then  a  salivation  continued  for  weeks 
£nd  months  after  the  crisis  of  this  fever,  to  the  great 
distress  of  the  patient,  and  injury  of  the  credit  of 
mercury  as  a  remedy  in  this  disease.  Dr.  Phy- 
sick  has  discovered,  that  in  these  cases  the  saliva- 
tion is  kept  up  by  carious  teeth  or  bone,  and  that 
it  is  to  be  cured  only  by  removing  them. 

From  the  impracticability  of  exciting  a  salivation 
in  all  cases,  I  attempted  the  cure  of  this  fever,  af- 
ter bleeding,  by  means  of  copious  sweats.  They 
succeeded  in  several  instances  where  no  other  re- 
medy promised  or  afforded  any  relief.  They  were 
excited  by  wrapping  the  patient  in  a  blanket,  with 
half  a  dozen  hot  bricks  wetted  with  vinegar,  and 
applied  to  different  parts  of  the  body.     The  sweat- 


BILIOUS    YELLOW    FEVER    OF    1798.  83 

ing  was  continued  for  six  hours,  and  repeated  daily 
for  four  or  five  days. 

In  those  cases  where  the  fever  put  on  the  form 
of  an  intermittent,  I  gave  bark  after  bleeding  and 
purging  with  advantage.  I  gave  it  likewise  in  ail 
those  cases  where  the  fever  put  on  the  type  of  the 
slow  chronic  fever.  Laudanum  was  acceptable 
and  useful  in  many  cases  of  pain,  wakefulness,  vo- 
miting, and  diarrhoea,  after  the  use  of  depleting  re- 
medies. 

I  applied  blisters  in  the  usual  way  in  this  fever, 
but  I  think  with  less  effect  than  in  the  yellow  fevers 
of  former  years. 

To  relieve  a  vomiting,  which  was  very  distres- 
sing in  many  cases  about  the  fourth  and  fifth  days, 
I  gave  a  julep,  composed  of  the  salt  of  tartar  and 
laudanum.  I  also  gave  Dr.  Hosack's  anti-emetic 
medicine,  composed  of  equal  parts  of  lime-water 
and  milk.  I  do  not  know  that  it  saved  any  lives, 
but  I  am  sure  it  gave  ease  by  removing  a  painful 
symptom,  and  thus,  where  it  did  not  cure,  lessened 
the  sufferings  of  the  sick. 

The  diet  and  drinks  were  the  same  in  this  fever 
as  they  were  in  the  fevers  formerly  described. 


AN    ACCOUNT    OF    THE 

Cool  air,  cold  water,  and  cleanliness  produced 
their  usual  salutary  effects  in  this  fever. 

I  shall  now  deliver  a  short  account  of  the  symp- 
toms which  indicated  a  favourable  and  an  unfavour- 
able issue  of  the  disease. 

It  has  been  said*,  that  the  signs  of  danger  vary 
in  this  fever,  from  the  influence  of  the  weather. 
The  autumn  of  1798  confirmed,  in  many  instances, 
the  truth  of  this  remark. 

I  saw  no  instance  of  death  where  a  bleeding  oc- 
curred from  the  gums  on  the  fourth  or  fifth  day, 
provided  depleting  remedies  had  been  used  from 
the  beginning  of  the  disease.  Few  recovered  who 
had  this  symptom  in  1793. 

I  saw  three  recoveries  after  convulsions  in  the 
year  1798.  All  died  who  were  convulsed  in  1793 
and  1797. 

A  dry,  hoarse,  and  sore  throat  was  followed  by 
death  in  every  case  in  which  it  occurred  in  my 
practice.  In  the  fever  of  1793  a  sore  throat  was  a 
favourable  sign.     It  was  one  of  the  circumstances 

*  History  of  the  Fever  in  1797. 


BILIOUS    YELLOW    FEVER    OF    1798.  85 

which  determined  me  to  use  a  salivation  in  that 
fever. 

The  absence  of  pain  was  always  a  bad  sign. 
Small,  but  frequent  stools,  and  the  continuance  of 
a  redness  in  the  eyes  after  the  ample  use  of  deplet- 
ing remedies,  were  likewise  bad  signs. 

An  appetite  for  food  on  the  fourth  or  fifth  day  of 
the  fever,  without  a  remission  or  cessation  of  the 
fever,  was  always  unfavourable. 

A  want  of  delicacy,  in  exposing  parts  of  the 
body  which  are  usually  covered,  was  a  bad  symp- 
tom. I  saw  but  one  recovery  where  it  took  place. 
Boccacio  says  the  same  symptom  occurred  in  the 
plague  in  Italy.  "  It  suspended  (he  tells  us)  all 
modesty,  so  that  young  women,  of  great  rank  and 
delicacy,  submitted  to  be  attended,  dressed,  and 
even  cleansed  by  male  nurses." 

I  have  remarked,  in  another  place,  that  but  two 
of  my  patients  recovered  who  had  the  hiccup. 

A  dry  tongue  was  a  bad  sign.  I  saw  but  one 
recoverv  where  it  occurred,  and  none  where  the 
tongue  was  black.  A  moist  and  natural  tongue, 
where  symptoms  of  violence  or  malignity  appeared 


86  AN    ACCOUNT    OF    TH£ 

in  other  parts  of  the  body,  was  always  followed  by 
a  fatal  issue  of  the  disease. 

A  desire  to  ride  out,  or  to  go  home,  in  persons 
who  were  absent  from  their  families,  was,  in  every 
instance  where  it  took  place,  a  fatal  symptom. 
These  desires  arose  from  an  insensibility  to  pain, 
or  a  false  idea  of  the  state  of  the  disease.  It  exist- 
ed to  such  a  degree  in  some  of  the  patients  in  the 
city  hospital,  that  they  often  left  their  beds,  and 
dressed  themselves,  in  order  to  go  home.  All 
these  patients  died,  and  some  of  them  in  the  act  of 
putting  on  their  clothes. 

From  the  history  that  has  been  eiven  of  the 
symptoms,  treatment,  and  prognosis  of  this  fever, 
we  see  how  imperfect  all  treatises  upon  epidemics 
must  be,  which  are  not  connected  with  climate  and 
season.  As  well  might  a  traveller  describe  a  fo- 
reign climate,  by  the  state  of  the  weather,  or  by 
the  productions  of  the  earth,  during  a  single  au» 
tumn,  as  a  physician  adopt  a  uniform  opinion  of 
the  history,  treatment,  and  prognosis  of  a  fever, 
from  its  phenomena  in  any  one  country,  or  during 
a  single  season. 

o 

There  were  three  modes  of  practice  used  in  this 
epidemic.     The  first  consisted  in  the  exhibition  of 


BILIOUS    YELLOW    FEVER    OF    1798.  87 

purges  of  castor  oil,  salts,  and  manna,  and  cooling 
glysters,  and  in  the  use  of  the  warm  bath.  These 
remedies  were  prescribed  chiefly  by  the  French 
physicians.  The  second  consisted  in  the  use  of 
mercury  alone,  in  such  doses,  and  in  such  a  manner, 
as  to  excite  a  salivation.  This  mode  was  used  chiefly 
by  an  itinerant  and  popular  quack.  The  third 
mode  consisted  in  using  all  the  remedies  which  I 
have  mentioned  in  the  account  of  the  treatment  of 
this  fever,  and  accommodating  them  to  the  state  of 
the  disease.  This  mode  of  practice  was  followed 
by  most  of  the  American  physicians. 

The  first  mode  of  practice  was  the  least  success, 
ful.  It  succeeded  only  in  such  cases  as  would 
probably  have  cured  themselves. 

The  second  mode  succeeded  in  mild  cases,  and 
now  and  then  in  that  malignant  state  of  the  fever, 
in  which  the  action  of  the  blood-vessels  was  so 
much  prostrated  by  the  force  of  the  miasmata,  as 
to  permit  the  mercury  to  pass  over  them,  and  thus 
to  act  upon  the  salivary  glands  in  the  course  of 
four  or  five  days. 

The  last  mode  was  by  far  the  most  successful. 
It  is  worthy  of  notice,  that  the  business  and  repu- 
tation of  the  physicians,  during  this  epidemic,  were 


88  AN    ACCOUNT    OF    THE 

in  the  inverse  ratio  of  their  success.  The  number 
of  deaths  by  it  amounted  to  between  three  and  four 
thousand,  among  whom  were  three  physicians,  and 
two  students  of  medicine.  Its  mortality  was  nearly 
as  great  as  it  was  in  1793,  and  yet  the  number^of 
people  who  were  affected  by  it  was  four  times  as 
great  in  1793  as  it  was  in  1798,  for,  in  the  latter 
year,  the  city  was  deserted  by  nearly  all  its  inhabi- 
tants. The  cause  of  this  disproportion  of  deaths 
to  the  number  who  were  sick,  was  owing  to  the 
liberal  and  general  use  of  the  lancet  in  1793,  and 
to  the  publications  in  1797  having  excited  general 
fears  and  prejudices  against  it  in  1798.  Such  was 
the  influence  of  these  publications,  that  many  per- 
sons who  had  recovered  from  this  fever  in  the 
two  former  years,  by  the  use  of  depleting  remedies, 
deserted  the  physicians  who  had  prescribed  them, 
and  put  themselves  under  the  care  of  physicians  of 
opposite  modes  of  practice.  Most  of  them  died. 
Two  of  them  had  been  my  patients,  one  of  whom 
had  recovered  of  a  third  attack  of  the  fever  under 
my  care. 


AN  ACCOUNT 


OF    THE 


BILIO  US  TELL  OW  FE  VER, 


AS    IT 


APPEARED  IN  PHILADELPHIA, 

IN  THE  YEAR    1799. 


VOL.   IV.  Hi 


AN  ACCOUNT,  0c, 


THE  diseases  which  succeeded  die  fever 
of  1798,  in  November  and  December,  were  highly 
inflammatory.  A  catarrh  was  nearly  universal.  Se- 
veral cases  of  sore  throat,  and  one  of  erysipelas, 
came  under  my  care  in  the  month  of  November. 
The  weather  in  December  was  extremely  cold.  It 
was  equally  so  in  the  beginning  of  January,  1 799, 
accompanied  with  several  falls  of  snow. 

About  the  middle  of  the  month,  the  weather  mo- 
derated so  much,  so  as  to  open  the  navigation  of 
the  Delaware.  I  met  with  two  cases  of  malignant 
colic  in  the  latter  part  of  this  month,  and  one  of 
yellow  fever.  The  last  was  Swen  Warner.  Dr. 
Physick,  who  attended  him  with  me,  informed  me 
that  he  had,  nearly  at  the  same  time,  attended  two 
other  persons  with  the  same  disease. 


92  AN    ACCOUNT    OF    THE 

The  weather  was  very  cold,  and  bilious  pleuri- 
sies were  common,  during  the  latter  part  of  the 
month  of  February. 

March  was  equally  cold.  The  newspapers  con- 
tained accounts  of  the  winter  having  been  uncom- 
monly severe  in  Canada,  and  in  several  European 
countries. 

The  first  two  weeks  in  April  were  still  cold. 
The  Delaware,  which  had  been  frozen  a  second 
time  during  the  winter,  was  crossed  near  its  origin, 
on  the  ice,  on  the  15th  day  of  this  month.  The 
diseases,  though  fewer  than  in  the  winter,  were 
bilious  and  inflammatory.  During  this  month,  I 
was  called  to  a  case  of  yellow  fever,  which  yielded 
to  copious  bleeding,  and  other  depleting  medicines. 

May  was  colder  than  is  usual  in  that  month,  but 
very  healthy. 

In  the  first  week  of  June,  several  cases  of  highly 

- 

bilious  fever  came  under  my  care.  In  one  of  them, 
all  the  usual  symptoms  of  the  highest  grade  of  that 
fever  occurred.  On  the  13th  of  the  month,  Dr. 
Physick  informed  me,  that  he  had  lost  a  patient 
with  that  disease.  On  the  23d  of  the  same  month, 
Joseph  Ashmead,  a  young  merchant,  died  of  it 


BILIOUS    YELLOW    FEVER    OF    1799.  93 

Several  other  cases  of  the  disease  occurred  between 
the  20th  and  29th  days  of  the  month,  in  different 
parts  of  the  city.  About  this  time,  I  was  informed 
that  the  inhabitants  of  Keys's-alley  had  predicted  a 
return  of  the  yellow  fever,  from  the  trees  before  their 
doors  emitting  a  smell,  exactly  the  same  which  they 
perceived  just  before  the  breaking  out  of  that  dis- 
ease in  1793. 

In  July,  the  city  was  alarmed,  by  Dr.  Griffitts, 
with  an  account  of  several  cases  of  the  fever  in 
Penn- street,  near  the  water.  The  strictness  with 
which  the  quarantine  law  had  been  executed,  for  a 
while  rendered  this  account  incredible  with  many 
people,  and  exposed  the  doctor  to  a  good  deal  of 
obloquy.  At  length  a  vessel  was  discovered,  that 
had  arrived  from  one  of  the  West-India  islands 
on  the  14th  of  May,  and  one  day  before  the  qua- 
rantine law  was  put  into  operation,  from  which  the 
disease  was  said  to  be  derived.  Upon  investigat- 
ing the  state  of  this  vessel,  it  appeared  that  she  had 
arrived  with  a  healthy  crew,  and  that  no  person 
had  been  sick  on  board  of  her  during  her  voyage. 

In  the  latter  part  of  July  and  in  the  beginning  of 
August,  the  disease  gradually  disappeared  from 
every  part  of  the  city.     This  circumstance  deserves 


94  AN    ACCOUNT    0F    THE 

attention,  as  it  shows  the  disease  did  not  spread  by 
contagion. 

About  this  time  we  were  informed  by  the  news- 
papers, that  dogs,  geese,  and  other  poultry,  also 
that  wild  pigeons  were  sickly  in  many  parts  of 
the  country,  and  that  fish  on  the  Susquehannah, 
and  oysters  in  the  Delaware  bay,  were  so  unplea- 
sant, that  the  inhabitants  declined  eating  them. 
At  the  same  time,  flies  were  found  dead  in  great 
numbers,  in  the  unhealthy  parts  of  the  city.  The 
weather  was  dry  in  August  and  September.  There 
was  no  second  crop  of  grass.  The  gardens  yielded 
a  scanty  supply  of  vegetables,  and  of  an  inferior  size 
and  quality.  Cherries  were  smaller  than  usual, 
and  pear  and  apple-trees  dropped  their  fruits  prema- 
turely, in  large  quantities.  The  peaches,  which 
arived  at  maturity,  were  small  and  ill-tasted.  The 
grain  was  in  general  abundant,  and  of  a  good  qua- 
lity. A  fly,  of  an  unusual  kind,  covered  the  pota- 
toe  fields,  and  devoured,  in  some  instances,  the 
leaves  of  the  potatoe.  This  fly  has  lately  been  used 
with  success  in  our  country,  instead  of  the  fly  im- 
ported from  Spain.  It  is  equal  to  it  in  every  re- 
spect. Like  the  Spanish  fly,  it  sometimes  induces 
strangury. 


BILIOUS    YELLOW    FEVER    OF    1799.  95 

About  the  middle  of  August  the  disease  revived, 
and  appeared  in  different  parts  of  the  city.  A  pub- 
lication from  the  academy  of  medicine,  in  which 
they  declared  the  seeds  of  the  disease  to  spread  from 
the  atmosphere  only,  produced  a  sudden  flight  of  the 
inhabitants.  In  no  year,  since  the  prevalence  of 
the  fever,  was  the  desertion  of  the  city  so  general. 

I  shall  now  add  a  short  account  of  the  symptoms 
and  treatment  of  this  epidemic. 

The  arterial  system  was  in  most  cases  active.  I 
met  with  a  tense  pulse  in  a  patient  after  the  appear- 
ance of  the  black  vomiting.  Delirium  was  less 
frequent  in  adults  than  in  former  years.  In  chil- 
dren there  was  a  great  determination  of  the  disease 
to  the  brain. 

I  observed  no  new  symptoms  in  the  stomach 
and  bowels.  One  of  the  worst  cases  of  the  fever 
which  I  saw  was  accompanied  with  colic.  A  girl 
of  Thomas  Shortall,  who  recovered,  discharged  9 
worms  during  her  fever.  It  appeared  in  Mr.  Tho- 
mas Roan,  one  of  my  pupils,  in  the  form  of  a  dy- 
sentery. 

A  stiffness,  such  as  follows  death,  occurred  in 
several  patients  in  the  city  hospital  before  death. 


96  AN    ACCOUNT    OF    THE 

Miss  Shortall  had  an  eruption  of  pimples  on  her 
breast,  such  as  I  have  described  in  the  short  ac- 
count I  gave  of  the  yellow  fever  of  1762  in  this 
city,  in  my  account  of  the  disease  in  1793* 

The  blood  exhibited  its  usual  appearances  in  the 
yellow  fever.  It  was  seldom  sizy  till  towards  the 
close  of  the  disease. 

The  tongue  was  generally  whitish.  Sometimes 
it  was  of  a  red  colour,  and  had  a  polished  appear- 
ance. I  saw  no  case  of  a  black  tongue,  and  but 
few  that  were  yellow  before  the  seventh  day  of  the 
disease. 

The  type  of  this  disease  was  nearly  the  same 
as  described  in  1797.  It  now  and  then  ap- 
peared in  the  form  of  a  quartan,  in  which  state  it 
generally  proved  fatal.  It  appeared  with  rheumatic 
pains  in  one  of  my  patients.  It  blended  itself  with 
gout  and  small-pox.  Its  union  with  the  latter  dis- 
ease was  evident  in  two  patients  in  the  city  hospital, 
in  each  of  whom  the  stools  were  such  as  were  dis- 
charged in  the  most  malignant  state  of  the  fever. 

The  remedies  for  this  fever  were  bleeding,  vo- 
mits, purges,  sweats,  and  a  salivation  and  blisters. 


BILIOUS    YELLOW    FEVER    OF    1799.  97 

There  were  few  cases  that  did  not  indicate  bleed- 
ing. It  was  performed,  when  proper,  in  the  usual 
way,  and  with  its  usual  good  effects.  It  was  indi- 
cated as  much  when  the  disease  appeared  in  the 
bowels  as  in  the  blood-vessels.  Mr.  Roan,  in 
whom  it  was  accompanied  with  symptoms  of  dy- 
sentery, lost  nearly  200  ounces  of  blood  by  twenty- 
two  bleedings. 

I  found  the  same  benefit  from  emetics,  in  this 
fever,  that  I  did  in  the  fever  of  1798.  They  were 
never  administered  except  on  the  first  day,  before 
violent  action  had  taken  place  in  the  system,  or  af- 
ter it  was  moderated  by  one  or  two  bleedings. 

Purges  of  calomel  and  jalap,  also  castor  oil,  salts, 
and  injections  were  prescribed  with  their  usual  ad- 
vantages. 

In  those  cases  where  the  system  was  prostrated 
below  the  point  of  re-action,  I  began  the  cure  by 
sweating.  Blankets,  with  hot  bricks  wetted  with 
vinegar,  and  the  hot  bath,  as^  mentioned  formerly, 
when  practicable,  were  used  for  this  purpose. 
The  latter  produced,  in  a  boy  of  14  years  of  age, 
who  came  into  the  city  hospital  without  a  pulse, 
and  with  a  cold  skin,  in  a  few  hours,  a  general 
warmth  and  an  active  pulse.     The  determination 

vol.  IV.  N 


98  AN    ACCOUNT    OF    THE 

of  the  disease  to  the  pores  was  evinced  in  one  of 
my  patients,  by  her  sweating  under  the  use  of  the 
above-mentioned  remedies,  for  the  first  time  in  her 
life.  A  moisture  upon  her  skin  had  never  before 
been  induced,  she  informed  me,  even  by  the  wann- 
est day  in  summer. 

The  advantages  of  a  salivation  were  as  great  as 
in  former  years.  From  the  efficacy  of  bleeding, 
purges,  emetics,  and  sweating,  I  had  the  pleasure 
of  seeing  many  recoveries  before  the  mercury  had 
time  to  affect  the  mouth,  In  no  one  case  did  I 
rest  the  cure  exclusively  upon  any  one  of  these  re- 
medies. The  more  numerous  the  outlets  were  to 
convey  off  superfluous  fluids  and  excitement  from 
the  body,  the  more  safe  and  certain  were  the  reco- 
veries. A  vein,  the  gall-bladder,  the  bowels,  the 
pores,  and  the  salivary  glands  were  all  opened,  in 
succession,  in  part,  or  together,  according  to  cir- 
cumstances, so  as  to  give  the  disease  every  possible 
chance  of  passing  out  of  the  body  without  injuring 
or  destroying  any  of  its  vital  parts. 

Blisters  were  applied  with  advantage.  The  vo- 
miting and  sickness  which  attend  this  fever  were 
relieved,  in  many  instances,  by  a  blister  to  the  sto- 
mach. 


BILIOUS    YELLOW    FEVER    OF    1799.  99 

In  those  cases  in  which  the  fever  was  protracted 
to  the  chronic  state,  bark,  wine, laudanum,  and  aether 
produced  the  most  salutary  effects.  I  think  I  saw 
life  recalled,  in  several  cases  in  which  it  appeared 
to  be  departing,  by  frequent  and  liberal  doses  of 
the  last  of  those  medicines.  The  bark  was  given, 
with  safety  and  advantage,  after  the  seventh  day, 
when  the  fever  assumed  the  form  of  an  intermit- 
tent. 

The  following  symptoms  were  generally  favour- 
able, viz.  a  bleeding  from  the  mouth  and  gums, 
and  a  disposition  to  weep,  when  spoken  to  in  any 
stage  of  the  fever. 

A  hoarseness  and  sore  throat  indicated  a  fatal 
issue  of  the  disease,  as  it  did  in  1798.  Dr.  Phy- 
sick  remarked,  that  all  those  persons  who  sighed 
after  waking  suddenly,  before  they  were  able  to 
speak,  died. 

The  recurrence  of  a  redness  of  the  eyes,  after  it 
had  disappeared,  or  of  but  one  eye,  was  generally 
followed  by  death.  I  saw  but  one  recovery  with 
a  red  face. 

I  saw  several  persons,  a  few  hours  before  death, 
in  whom  the  countenance,  tongue,  voice,  and  pulse 


100  AN    ACCOUNT,    &C. 

Were  perfectly  natural.  They  complained  of  no 
pain,  and  discovered  no  distress  nor  solicitude  of 
mind.  Their  danger  was  only  to  be  known  by  the 
circumstances  which  had  preceded  this  apparently 
healthy  and  tranquil  state  of  the  system.  They 
had  all  passed  through  extreme  suffering,  and  some 
of  them  had  puked  black  matter. 

The  success  of  the  mode  of  practice  I  have  de- 
scribed was  the  same  as  in  former  years,  in  private 
families  ;  but  in  the  city  hospital,  which  was  again 
placed  under  the  care  of  Dr.  Physick  and  myself, 
there  was  a  very  different  issue  to  it,  from  causes 
that  are  too  obvious  to  be  mentioned. 

There  were  two  opinions  given  to  the  public  upon 
the  subject  of  the  origin  of  this  fever;  the  one  by  the 
academy  of  medicine,  the  other  by  the  college  of 
physicians.  The  former  declared  it  to  be  generated 
in  the  city,  from  putrid  domestic  exhalations,  be- 
cause they  saw  it  only  in  their  vicinity,  and  disco- 
vered no  channel  by  which  it  could  have  been 
derived  from  a  foreign  country  ;  the  latter  asserted 
it  to  be  "  imported,  because  it  had  been  imported 
in  former  years,-" 


AN 


ACCOUNT  OF  SPORADIC  CASES 


OF 


TELL  OW  FE  VER, 


AS    THEY 


APPEARED  IN  PHILADELPHIA, 


IN    1800. 


AN  ACCOUNT,  &c. 


THE  weather  in  the  month  of  January  was 
less  cold  than  is  common  in  that  month.  Catarrhs, 
the  cynanche  trachealis,  and  bilious  pleurisies  were 
prevalent  in  every  part  of  it.  A  few  cases  of  yel- 
low fever  occurred  likewise  during  this  month. 

Several  cases  of  erysipelas  appeared  in  February. 

The  month  of  March  was  unusually  healthy. 

The  weather  was  warm  in  April,  and  the  city  as 
healthy  as  in  March. 

It  was  equally  so  in  May  and  June.  The  spring 
fruits  appeared  early  in  the  latter  month,  in  large 
quantities,  and  were  of  an  excellent  quality.  Locusts 
were  universal  in  June.     They  had  not  appeared 


104       AN    ACCOUNT    OF    SPORADIC    CASES 

since  the  year  1783.  A  record  from  the  journal 
of  the  Swedish  missionaries  was  published  at  this 
time,  which  described  their  appearance  in  1715, 
in  which  year  it  was  said  to  be  very  healthy. 

On  the  14th  of  June  there  was  a  severe  thunder 
gust,  with  more  lightning  than  had  been  known  for 
seven  years  before. 

There  fell,  during  all  the  months  that  have  been 
mentioned,  frequent  and  plentiful  showers  of  rain, 
which  rendered  the  crops  of  grass  luxuriant  in  the 
neighbourhood  of  Philadelphia. 

The  winds  at  this  time  were  chiefly  from  the 
south-east. 

A  few  intermittents  appeared  in  June,  which 
yielded  readily  to  the  bark. 

On  the  16th  day  of  June,  Dr.  Physick  informed 
me  he  had  a  black  boy  under  his  care  with  the 
yellow  fever. 

In  July,  the  hooping  cough,  cholera  infantum, 
and  some  cases  of  dysentery  and  bilious  fever  ap- 
peared in  the  city. 


OF    YELLOW    FEVER    IN    1800.  105 

On  the  30th  of  July,  Dr.  Pascalis  informed  me 
that  he  had  lost  a  patient  on  the  fifth  day  of  a  yel- 
low fever. 

In  August,  the  dysentery  was  the  principal  form 
of  disease  that  prevailed  in  the  city. 

On  the  22d  of  this  month,  a  woman  died  of  the 
yellow  fever  in  Gaskill- street,  under  the  care  of  Dr. 
Church. 

On  the  28th  and  30th,  there  fell  an  unusual 
quantity  of  rain.  The  winds  were  south-west  and 
north  west  during  the  greatest  part  of  the  summer 
months.  The  latter  were  sometimes  accompanied 
with  rain. 

On  the  1 1th  of  September,  a  clerk  of  Mr.  Levi 
Hollingsworth,  and,  on  the  12th,  a  clerk  of  Mr, 
John  Connelly,  died  with  the  yellow  fever. 

A  plentiful  shower  of  rain  fell  on  the  night  of  the 
21st  of  this  month. 

About  this  time  there  appeared  one  and  twenty 
cases  of  yellow  fever  in  Spruce- street,  between 
Front  and  Second- streets.      They  were  all  in  the 

VOL.  iv,  o 


106       AN    ACCOUNT    OF    SPORADIC    CASES 

neighbourhood  of  putrid  exhalations.      Fourteen 
of  them  ended  fatally. 

No  one  of  the  above  cases  of  malignant  fever 
could  be  traced  to  a  ship,  or  to  a  direct  or  indirect 
intercourse  with  persons  affected  by  that  disease. 

While  Philadelphia  was  thus  visited  by  a  few 
sporadic  cases  only  of  yellow  fever,  it  was  epide- 
mic in  several  of  the  cities  of  the  United  States, 
particularly  in  New- York,  Providence,  in  Rhode 
Island,  Norfolk,  and  Baltimore.  In  the  last  named 
place,  it  was  publicly  declared  by  the  committee 
of  health  to  be  of  domestic  origin. 

The  dysentery  was  epidemic,  at  the  same  time, 
in  several  of  the  towns  of  Massachusetts  and  New- 
Hampshire.  It  was  attended  with  uncommon 
mortality  at  Hanover,  in  the  latter  state. 

This  difference  in  the  states  of  health  and  sick- 
ness in  the  different  parts  of  the  United  States  must 
be  sought  for  chiefly  in  the  different  states  of  the 
weather  in  those  places.  The  exemption  of  Phila- 
delphia from  the  yellow  fever,  as  an  epidemic,  may 
perhaps  be  ascribed  to  the  strength  and  vigour  of 
the  vegetable  products  of  the  year,  which  retarded 
their  putrefaction ;    to  frequent  showers  of  rain, 


OF    YELLOW    FEVER    IN    1800.  107 

which  washed  away  the  filth  of  the  streets  and  gut- 
ters ;  and  to  the  perfection  of  the  summer  and  au- 
tumnal fruits. 

The  months  of  November  and  December  this 
year  were  uncommonly  healthy.  During  the  for- 
mer, several  light  shocks  of  earthquakes  were  felt 
in  Lancaster  and  Harrisburg,  in  Pennsylvania,  and 
in  Wilmington,  in  the  state  of  Delaware. 


AN 


ACCOUNT  OF  SPORADIC  CASES 


OF 


YELLOW  FEVER, 


AS    THEY 


APPEARED  IN  PHILADELPHIA, 


in    1801. 


AN  ACCOUNT,  &c. 


THE  month  of  January  was  intensely  cold. 
In  February  it  became  more  moderate.  The  dis- 
eases, during  these  two  months,  were  catarrhs  and 
a  few  pleurisies. 

In  March  and  April  there  fell  an  unusual  quan- 
tity of  rain.  The  hay  harvest  began  in  the  neigh- 
bourhood of  Philadelphia  on  the  28th  of  May.  A 
few  mild  cases  of  scarlatina  anginosa  occurred  dur- 
ing these  months. 

In  June  the  weather  was  dry  and  healthy. 

On  the  8th  of  July,  a  case  of  yellow  fever  oc- 
curred in  the  practice  of  Dr.  Stewart.  About  the 
15th  of  the  month,  a  patient  died  with  it  in  the 
Pennsylvania  hospital.     Dr.  Physick  informed  me 


112       AN    ACCOUNT    OF    SPORADIC    CASES 

that  he  had,  at  the  same  time,  two  patients  under 
his  care  with  that  disease.  Several  cases  of  the 
measles  appeared  in  the  south  end  of  the  city  dur- 
ing this  month.  In  every  part  of  it,  the  weather 
was  warm  and  dry,  in  consequence  of  which  there 
were  no  second  crops  of  grass,  and  a  smaller  quan- 
tity than  usual  of  summer  fruits  and  vegetables. 
The  winds  were  less  steady  than  they  had  been  for 
seven  years.  They  blew,  every  two  or  three  days, 
from  nearly  every  point  of  the  compass. 

On  the  4th  of  August  there  fell  a  considerable 
quantity  of  rain,  which  wras  succeeded  by  cool  and 
pleasant  weather.  The  cholera  morbus  was  a  fre- 
quent disease  among  both  adults  and  children  in 
the  city,  and  the  dysentery  in  several  of  the  adjoin- 
ing counties  of  the  state. 

A  number  of  emigrant  families  arrived  this  month 
from  Ireland  and  Wales,  who  brought  with  them 
the  ship  fever.  They  were  carefully  attended,  at 
the  lazaretto  and  the  city  hospital,  in  airy  rooms, 
by  which  means  they  did  not  propagate  the  disease. 
Contrary  to  its  usual  character,  it  partook  of  the 
remissions  of  the  bilious  fever,  probably  from  the 
influence  of  the  season  upon  it. 


OF    YELLLOW    FEVER    IN     1801*  113T 

In  September  there  were  a  few  extremely  warm 
days.  In  the  beginning  and  middle  of  the  month 
a  number  of  mild  remittents  occurred,  and  about 
the  22d  there  were  five  or  six  cases  of  yellow  fever 
in  Eighth-street,  between  Chesnut  and  Walnut- 
streets,  in  two  houses  ill  ventilated,  and  exposed  to 
a  good  deal  of  exhalation.  I  attended  most  of  these 
cases  in  consultation  with  Dr.  Gallaher.  One  of 
the  persons  who  was  affected  with  this  fever  puked 
black  matter  while  I  sat  by  his  bed-side,  a  few  hours 
before  he  died. 

During  the  summer  and  autumn  of  this  year,  a 
number  of  cases  of  yellow  fever  appeared  at  New- 
Bedford,  Portland,  and  Norwich,  in  the  New- Eng- 
land states  ;  in  New- York  ;  in  some  parts  of  New- 
Jersey  ;  and  in  Northampton  and  Bucks  counties, 
in  Pennsylvania.  It  prevailed  so  generally  in  New- 
York,  as  to  produce  a  considerable  desertion  of  the 
city.  In  none  of  the  above  places  could  the  least 
proof  be  adduced  of  the  disease  being  imported. 
In  Philadelphia  its  existence  was  doubted  or  denied 
by  most  of  the  citizens,  because  it  appeared  in  si- 
tuations remote  from  the  water,  and  of  course  could 
not  be  derived  from  any  foreign  source. 

It  will  be  difficult  to  tell  why  the  fever  appeared 
only  in  sporadic  cases  in  Philadelphia.    Perhaps  its 

VOL.   IV.  p 


114  AN   ACCOUNT  OF   SPORADIC   CASES,  &C. 

prevalence  as  an  epidemic  was  prevented  by  the 
plentiful  rains  in  the  spring  months,  by  the  absence 
of  moisture  from  the  filth  of  the  streets  and  gutters, 
in  consequence  of  the  dry  weather  in  June  and  July, 
by  the  vigour  and  perfection  of  the  products  of  the 
earth,  and  by  the  variable  state  of  the  winds  in  the 
month  of  July.  If  none  of  these  causes  defended 
the  city  from  more  numerous  cases  of  the  yellow 
fever,  it  must  be  resolved  into  the  want  of  a  con. 
curring  inflammatory  constitution  of  the  atmos- 
phere with  the  common  impure  sources  of  that 
disease. 

On  the  12th  of  November,  about  twelve  o'clock 
in  the  night,  an  earthquake  was  felt  in  Philadelphia, 
attended  with  a  noise  as  if  something  heavy  had 
fallen  upon  a  floor.  Several  cases  of  scarlet  fever 
appeared  in  December,  but  the  prevailing  disease, 
during  the  two  last  autumnal  and  the  first  winter 
months,  was  the  measles.  I  have  taken  notice  that 
it  appeared  in  the  south  end  of  the  city  in  July, 
During  the  months  of  August  and  September  it 
was  stationary,  but  in  October,  November,  and 
December  it  spread  through  every  part  of  the  city. 
The  following  circumstances  occurred  in  this  epi- 
demic, as  far  as  it  came  under  my  notice. 


AN  ACCOUNT 


OF 


THE  MEASLES, 


AS   THEY 


APPEARED  IN  PHILADELPHIA, 

IN    THE    YEAR     1  80  L 


i 


AN  ACCOUNT,  &c. 


I.  THE  disease  wore  the  livery  of  the  au- 
tumnal fever  in  the  following  particulars. 

It  was  strongly  marked  by  remissions  and  inter- 
missions. The  exacerbations  came  on  chiefly  at 
night. 

There  were  in  many  cases  a  constant  nausea,  and 
discharge  of  bile  by  puking. 

I  saw  one  case  in  which  the  disease  appeared 
with  a  violent  cholera  morbus,  and  several  in  which 
it  was  accompanied  with  diarrhoea  and  dysentery. 

II.  Many  severe  cases  of  phrenzy,  and  two  of 
cynanche  trachealis  appeared  with  the  measles. 


118  AN  ACCOUNT  OF    THE 

III.  A  distressing  sore  mouth  followed  them,  in 
a  child  of  two  years  old,  that  came  under  my  care. 

IV.  A  fatal  hydrocephalus  internus  followed  them 
in  a  boy  of  eight  years  old,  whom  I  saw  two  days 
before  he  died. 

• 

V.  I  met  with  a  few  cases  in  which  the  fever 
and  eruption  came  on  in  the  same  day,  but  I  saw 
one  case  in  which  the  eruption  did  not  take  place 
until  the  tenth,  and  another,  in  which  it  did  not  ap- 
pear until  the  fourteenth  day  after  the  fever. 

VI.  Two  children  had  pustules  on  their  skins, 
resembling  the  small-pox,  before  the  eruption  of 
the  measles. 

VII.  Many  children  had  coughs  and  watery  eyes, 
but  without  the  measles.  The  same  children  had 
them  two  or  three  weeks  afterwards. 

VIII.  Many  people  who  had  had  the  measles, 
had  coughs  during  the  prevalence  of  the  measles, 
resembling  the  cough  which  occurs  in  that  disease. 

The  remedies  made  use  of  in  my  practice  were, 


MEASLES    IN    1801.  119 

1.  Bleeding,  from  four  to  sixty  ounces,  accord- 
ing to  the  age  of  the  patient,  and  the  state  of  the 
pulse.  This  remedy  relieved  the  cough,  eased 
the  pains  in  the  head,  and  in  one  case  produced, 
when  used  a  third  time,  an  immediate  eruption  of 
the  measles. 

2.  Lenient  purges. 

3.  Demulcent  drinks, 

4.  Opiates  at  night. 

5.  Blisters.     And, 

6.  Astringent  medicines,  where  a  diarrhoea  took 
place. 

I  saw  evident  advantages  from  advising  a  vege- 
table diet  to  many  children,  as  soon  as  any  one  of 
the  families  to  which  they  belonged  were  attacked 
by  the  measles. 

I  lost  but  one  patient  in  this  disease,  and  that 
was  a  child  in  convulsions.  I  ascribed  my  success 
to  bleeding  more  generally  and  more  copiously  than 
I  had  been  accustomed  to  do,  in  the  measles  of  for- 


mer  vears. 


AN  ACCOUNT 


OF    THE 


BILIOUS  TELLOW  FEVER, 


AS   IT 


APPEARED  IN  PHILADELPHIA, 

IN  THE  YEAR    1802, 


VOL.  IT. 


AN  ACCOUNT,  &c. 


THE  weather  during  the  month  of  January 
was  unusually  moderate  and  pleasant.  In  the  latter 
end  of  it,  many  shrubs  put  forth  leaves  and  blos- 
somed. I  saw  a  leaf  of  the  honeysuckle,  which  was 
more  than  an  inch  in  length,  and  above  half  an  inch 
in  breadth.  There  was  but  one  fall  of  snow,  and 
that  a  light  one,  during  the  whole  month. 

The  winds  blew  chiefly  from  the  south-west  in 
February.  There  was  a  light  fall  of  snow  on  the 
6th.  A  shad  was  caught  in  the  Delaware,  near  the 
city,  on  the  17th.  On  the  18th  and  19th  of  the 
month,  the  weather  became  suddenly  very  cold. 
On  the  22d  there  was  a  snow  storm,  and  on  the 
28th,  rain  and  a  general  thaw. 


124  AN    ACCOUNT    OF    THE 

In  March,  the  weather  was  wet,  cold,  and  stormy, 
with  the  exception  of  a  few  pleasant  days. 

The  scarlatina  anginosa  and  the  cynanche  trache- 
alis  were  the  principal  diseases  that  prevailed  dur- 
ing the  three  months  that  have  been  mentioned. 

■ 

In  April,  there  were  several  frosts,  which  de- 
stroyed the  blossoms  of  the  peach-trees. 

In  May,  the  weather  was  so  cool  as  to  make  fires 
agreeable  to  the  last  day  of  the  month.  The  wind 
blew  chiefly,  during  the  whole  of  it,  from  the  north- 
east. 

The  scarlatina  continued  to  be  the  reigning  dis- 
ease. I  saw  one  fatal  case  of  it,  in  which  a  redness 
only,  without  any  ulcers  or  sloughs,  appeared  in 
the  throat ;  and  I  attended  another,  in  which  a  total 
immobility  in  the  limbs  was  substituted  by  nature 
for  the  pain  and  swellings  in  those  parts  which  ge- 
nerally attend  the  disease.  There  were  three  distinct 
grades  of  this  epidemic.  It  was  attended  with  such 
inflammatory  or  malignant  symptoms,  in  some  in- 
stances, as  to  require  two  or  three  bleedings  ;  in 
others  it  appeared  with  a  typhoid  pulse,  which  yield- 
ed to  emetics :  turbith  mineral  was  preferred  for  this 


BILIOUS    YELLOW    FEVER    OF    1802.       125 

purpose ;  while  a  redness,  without  a  fever,  which 
yielded  to  a  single  purge,  was  the  only  symptom  of 
it  in  many  people. 

The  weather  was  cool,  rainy,  and  hot,  in  suces- 
sion,  in  the  month  of  June.  The  scarlatina  conti- 
nued to  be  the  prevailing  disease. 

During  the  first  and  second  weeks  in  July,  there 
fell  a  good  deal  of  rain.  On  the  4th  of  the  month 
I  was  called  to  visit  Mrs.  Harris,  in  Front- street, 
between  Arch  and  Market- streets,  with  a  bilious 
fever.  The  scarlatina  had  imparted  to  it  a  general 
redness  on  her  skin,  which  induced  her  to  believe 
it  was  that  disease,  and  to  neglect  sending  for  me- 
dical relief  for  several  days.  She  died  on  the  13  th 
of  the  month,  with  a  red  eye,  a  black  tongue,  hic- 
cup, and  a  yellow  skin.  Three  other  cases  of  ma- 
lignant bilious  fever  occurred  this  month.  Two 
of  them  were  attended  by  Dr.  Dewees  and  Dr. 
Otto. 

On  the  15th  of  the  month,  the  city  was  alarmed 
by  an  account  of  this  fever  having  appeared  near  the 
corners  of  Front  and  Vine-streets,  a  part  of  the  citv 
which  had  for  many  weeks  before  been  complained 
of  by  many  people  for  emitting  a  foetid  smell,  de- 
rived from  a  great  quantity  of  filthy  matters  stag- 


126  AN    ACCOUNT    OF    THE 

nating  in  that  neighbourhood,  and  from  the  foul 
air  discharged  from  a  vessel  called  the  Esperanza, 
which  lay  at  Vine- street  wharf. 

On  the  2d  of  August,  it  appeared  in  other  parts 
of  the  city,  particularly  in  Front  and  Water- streets, 
near  the  draw-bridge,  where  it  evidently  originated 
from  putrid  sources.  Reports  were  circulated  that 
it  was  derived  from  contagion,  conveyed  to  Vine- 
street  wharf  in  the  timbers  of  a  vessel  called  the  St. 
Domingo  Packet,  but  faithful  and  accurate  inqui- 
ries proved  that  this  vessel  had  been  detained  one 
and  twenty  days,  and  well  cleaned  at  the  lazaretto, 
and  that  no  one,  of  fourteen  men  who  had  worked 
on  board  of  her  afterwards,  had  been  affected  with 
sickness  of  any  kind. 

On  the  5th  of  August,  the  board  of  health  pub- 
licly declared  the  fever  to  be  contagious,  and  ad- 
vised an  immediate  desertion  of  the  city.  The 
advice  was  followed  with  uncommon  degrees  of 
terror  and  precipitation. 

The  disease  continued,  in  different  parts  of  the 
city,  during  the  whole  of  August  and  September. 
On  the  5th  of  October,  the  citizens  were  publicly 
invited  from  the  country  by  the  board  of  health. 


BILIOUS    YELLOW    FEVER    OF    1802.       127 

During  this  season,  the  yellow  fever  was  epide- 
mic in  Baltimore  and  Wilmington.  It  the  former 
place  it  was  admitted  by  their  board  of  health,  and 
in  the  latter  it  was  proved  by  Dr.  Vaughan,  to  be 
of  domestic  origin.  It  prevailed,  at  the  same  time, 
in  Sussex  county  and  near  Woodbury,  in  New- 
Jersey.  Sporadic  cases  of  it  likewise  occurred  in 
New- York  and  Boston,  and  in  Portsmouth,  in 
New- Hampshire.  The  chronic  fever  was  epide- 
mic in  several  of  the  towns  of  North- Carolina ; 
cases  of  fever,  which  terminated  in  a  swelling  and 
mortification  of  the  legs,  and  in  death  on  the  third 
day,  appeared  on  the  waters  of  the  Juniata,  in  Penn- 
sylvania ;  and  bilious  fevers,  of  a  highly  inflamma- 
tory grade,  were  likewise  common  near  German- 
town  and  Frankford,  in  the  neighbourhood  of  Phi,, 
ladelphia. 

But  few  of  the  cases  of  yellow  fever  which  have 
been  mentioned  came  under  my  care,  but  I  saw  a 
considerable  number  of  fevers  of  a  less  violent 
grade.  They  were  the  inflammatory,  bilious,  mild 
remitting,  chronic,  and  intermitting  fevers,  and 
the  febrieula.  They  appeared,  in  some  instances, 
distinct  from  each  other,  but  they  generally  blend- 
ed their  symptoms  in  their  different  stages.  The 
yellow  fever  often  came  on  in  the  mild  form  of  an 
intermittent,  and  even  a  febrieula,  and  as  often, 


123  AN    ACCOUNT    OF    THE 

after  a  single  paroxysm,  ended  in  a  mild  remittent 
or  chronic  fever.  When  it  appeared  in  the  latter 
form,  it  was  frequently  attended  with  a  slow  or  low 
pulse,  and  a  vomiting  and  hiccup,  such  as  attend  in 
the  yellow  fever.  This  diversity  of  symptoms, 
with  which  the  summer  and  autumnal  fever  came 
on,  made  it  impossible  to  decide  upon  its  type  on 
the  day  of  its  attack.  Having  been  deceived  in 
one  instance,  I  made  it  a  practice  afterwards  to 
watch  every  case  I  was  called  to  with  double  vigi- 
lance, lest  it  should  contract  a  malignant  form  in 
my  hands,  without  my  being  prepared  to  meet  it. 
Of  the  five  original  and  obvious  cases  of  yellow  fe- 
ver to  which  1  was  called,  I  saved  none,  for  I  saw 
but  one  of  them  before  the  last  stage  of  the  disease. 
In  many  others,  I  have  reason  to  believe  I  pre- 
vented that  malignant  form  of  fever,  by  the  early 
and  liberal  use  of  depleting  medicines.  The  prac- 
tice of  those  physicians  who  attended  most  of  the 
persons  who  had  the  yellow  fever,  was  much  less 
successful  than  in  our  former  epidemics.  I  sus- 
pected at  the  time,  and  I  was  convinced  afterwards, 
that  it  was  occasioned  by  relying  exclusively  upon 
bleeding,  purges,  and  mercury.  The  skin,  in  se- 
veral of  the  cases  which  I  saw,  was  covered  with 
moisture.  This  clearly  pointed  out  nature's  at- 
tempt to  relieve  herself  by  sweating.  Upon  my 
mentioning  this  fact  to  the  late  Dr.  Pfeiffer,  jun. 


BILIOUS    YELLOW    FEVER    OF    1802.       129 

he  instantly  adopted  my  opinion,  and  informed  me, 
as  a  reason  for  doing  so,  that  he  had  heard  of  seve- 
ral whole  families  in  the  Northern  Liberties,  where 
the  disease  prevailed  most,  who,  by  attacking  it  in 
its  forming  state  by  profuse  sweats,  had  cured  them- 
selves, without  the  advice  of  a  physician. 


v©l.  iv.  » 


AN  ACCOUNT 


OF    THE 


BILIOUS  YELLOW  FEVER, 


AS   IT 


APPEARED  IN  PHILADELPHIA, 

in   1803. 


AN  ACCOUNT,  &c. 


THE  weather  in  January  was  uniformly 
cold.  On  the  21st  of  the  month,  the  Delaware 
was  completely  frozen. 

On  the  4th  of  February  there  was  a  general  thaw, 
attended  with  a  storm  of  hail,  thunder,  and  light- 
ning, which  lasted  about  three  quarters  of  an  hour. 
The  diseases  of  both  these  winter  months  were 
catarrhs  and  bilious  pleurisies.  The  latter  appeared 
in  a  tertian  type.  The  pain  in  the  side  was  most 
sensible  every  other  day. 

The  weather  was  cold  and  dry  in  March,  in 
consequence  of  which,  vegetation  was  unusually 
backward  in  April.  The  hooping  cough,  catarrhs, 
and  scarlatina  were  the  diseases  of  this  month. 


134  AN    ACCOUNT    OF    THE 

The  beginning  of  May  was  very  cool.  There 
was  ice  on  the  7th  of  the  month.  The  winds,  dur- 
ing the  greatest  parts  of  this  and  the  previous 
month,  were  from  the  north-east. 

In  June,  the  weather  was  cool.  Intermittents 
were  common  in  this  month,  as  well  as  in  May. 
Such  was  the  predominance  of  this  type  of  fever 
over  all  other  diseases,  that  it  appeared  in  the 
form  of  profuse  sweats,  every  other  night,  in  a  lady 
under  the  care  of  Dr.  Dewees  and  myself,  in  the  pu- 
erperile  fever.  On  the  intermediate  nights  she  had  a 
fever,  without  the  least  moisture  on  her  skin.  There 
were  a  few  choleras  this  month.  During  the  lat- 
ter end  of  the  month,  I  lost  a  patient  with  many  of 
the  symptoms  of  yellow  fever. 

s  The  weather  in  July  was  alternately  hot,  mode- 
rate, and  cool,  with  but  little  rain.  The  first  two 
weeks  of  this  month  were  healthy.  A  few  tertian 
fevers  occurred,  which  readily  yielded  to  bark, 
without  previous  bleeding.  Between  the  25th  and 
31st  of  the  month,  three  deaths  took  place  from  the 
yellow  fever. 

In  the  month  of  August,  the  weather  was  the  same 
as  in  July,  except  that  there  fell  more  rain  in  it. 
Mild  remittents  and  cholera  infantum  were  now 


BILIOUS    YELLOW    FEVER    OF    1803.       135 

common.  There  were  likewise  several  oases  of 
yellow  fever  during  this  month.  One  of  them  was 
in  Fromberger's-court.  It  was  induced  by  the 
foe  tor  of  putrid  fish  in  a  cellar.  A  malignant  dysen- 
tery was  epidemic  during  this  month  in  the  upper 
part  of  Germantown,  and  in  its  neighbourhood.  Se- 
veral persons,  Dr.  Bensell  informed  me,  died  of  it 
in  thirty  hours  sickness.  It  prevailed,  at  the  same 
time,  in  many  parts  of  the  New-England  states. 

In  September,  cases  of  yellow  fever  appeared  in 
different  parts  of  the  city,  but  chiefly  in  Water, 
near  Walnut- street.  On  the  12th  of  the  month, 
the  board  of  health  published  a  declaration  of  its 
existence  in  the  city,  but  said  it  was  not  contagious. 
This  opinion  gave  great  offence,  for  it  was  generally 
said  to  have  been  imported  by  means  of  a  packet- 
boat  from  New- York,  where  the  fever  then  pre- 
vailed, because  a  man  had  sickened  and  died  in 
the  neighbourhood  of  the  wharf  where  this  packet 
was  moored.  It  was  to  no  purpose  to  oppose  to  this 
belief,  proofs  that  no  sick  person,  and  no  goods 
supposed  to  be  infected,  had  arrived  in  this  boat, 
and  that  no  one  of  three  men,  who  had  received  the 
seeds  of  the  disease  in  New- York,  had  communi- 
cated it  to  any  one  of  the  families  in  Philadelphia, 
in  which  they  had  sickened  and  died. 


136  AN    ACCOUNT    OF    THE 

The  disease  assumed  a  new  character  this  year, 
and  was  cured  by  a  different  force  of  medicine  from 
that  which  was  employed  in  some  of  the  years  in 
which  it  had  prevailed  in  Philadelphia. 

I  shall  briefly  describe  it  in  each  of  the  systems, 
and  then  take  notice  of  some  peculiarities  which  at- 
tended it.  Afterwards  I  shall  mention  the  reme- 
dies which  were  effectual  in  curing  it. 

1.  The  pulse  was  moderately  tense  in  most  cases. 
It  intermitted  in  one  case,  and  in  several  others  the 
tension  was  of  a  transient  nature. 

Haemorrhages  occured  in  many  cases.  They 
were  chiefly  from  the  nose,  but  in  some  instances 
they  occurred  from  the  stomach,  bowels,  and  hse- 
morrhoidal  vessels. 

2.  Great  flatulency  attended  in  the  stomach,  but 
sickness  and  vomiting  were  much  less  frequent 
than  in  former  years.  I  saw  but  one  case  in  which 
diarrhoea  attended  this  fever. 

3.  I  did  not  meet  with  a  single  instance  of  a 
glandular  swelling  in  any  part  of  the  body. 


BILIOUS    YELLOW    FEVER    OF    1803.       137 

4.  There  was  a  general  disposition  to  sweat  in 
this  fever  from  its  beginning.  Two  of  my  patients 
died,  in  whom  no  moisture  could  be  excited  on 
the  skin.  But  1  recovered  one  with  a  dry  skin,  by 
means  of  a  purge,  two  bleedings,  and  blisters. 

An  efflorescence  on  the  skin  occurred  in  several 
instances.  I  saw  black  matter  discharged  from  a 
blister  in  one  case,  and  blood  in  another. 

5.  The  stools  were  green  and  black.  Bile  was 
generally  discharged  in  puking. 

6.  The  blood  exhibited  the  following  appear- 
ances: siziness,  lotura  carnium,  sunken  crassamen- 
tum,  red  sediment,  and  what  is  called  dense  or  un- 
separated  blood.  I  saw  no  instance  of  its  being 
dissolved. 

7.  The  tongue  was  whitish  and  dark- coloured* 
This  diseased  appearance  continued,  in  some  in- 
stances, several  days  after  a  recovery  took  place^ 
I  saw  no  smooth,  red,  nor  black  tongue,  and  but 
One  dry  and  one  natural  tongue.  The  latter  was 
followed  by  death, 

I  did  not  see  a  single  case  in  which  the  disease 
came  on  without  an  exciting  cause ;   such  as  light 
vol.  iv.  s 


138  AN    ACCOUNT    OF    THE 

clothing  and  bed-clothes,  sitting  at  doors  after  night, 
a  long  walk,  gunning,  and  violent  and  unusual  ex- 
ercises of  any  kind.  It  was  excited  in  a  number 
of  people  by  their  exertions  to  extinguish  a  fire 
which  took  place  in  Water- street,  between  Market 
and  Chesnut-streets,  on  the  morning  of  the  25th  of 
August.  I  saw  a  fatal  instance  of  it  succeed  a  se- 
vere tooth-ach.  Whether  this  pain  was  the  ex- 
citing cause,  or  the  first  morbid  symptom  of  the 
fever,  I  know  not ;  but  I  was  led  by  it  to  bleed  a 
young  lady  twice  who  complained  of  that  pain,  and 
who  had  at  the  same  time  a  tense  pulse.  Her 
blood  had  the  usual  appearances  which  occur  in 
the  yellow  fever. 

The  disease  had  different  appearances  in  differ- 
ent parts  of  the  city.  It  was  most  malignant  in 
Water- street ;  but  in  many  instances  it  became  less 
so,  as  it  travelled  westward,  so  that  about  Ninth- 
street  it  appeared  in  the  form  of  a  common  inter- 
mittent. 

In  every  part  of  the  city  it  often  came  on,  as  in 
the  year  1802,  in  all  the  milder  forms  of  autumnal 
fever  formerly  enumerated,  and  went  off  with  the 
usual  symptoms  of  yellow  fever.  Again,  it  came 
on  with  all  the  force  and  malignity  of  a  yellow  fe- 
ver, and  terminated,  in  a  day  or  two,  in  a  common 


BILIOUS    YELLOW    FEVER    OF    1803.       139 

remittent  or  intermittent.  These  modes  of  attack 
were  so  common,  that  it  was  impossible  to  tell 
what  the  character,  or  probable  issue  of  a  fever 
would  be,  for  two  or  three  days. 

The  following  remedies  were  found,  very  ge- 
nerally, to  be  effectual  in  this  fever. 

1.  Moderate  bleeding.  I  bled  but  three  patients 
three,  and  only  one,  four  times.  In  general,  the 
loss  of  from  ten  to  twenty  ounces  of  blood,  reduced 
the  pulse  from  a  synocha  to  a  synoichoid  or  typhoid 
state,  and  thereby  prepared  the  system  for  other 
remedies. 

2.  Purges  were  always  useful.  I  gave  calomel 
and  jalap,  castor  oil,  salts,  and  senna,  according  to 
the  grade  of  the  disease,  and  often  according  to  the 
humour  or  taste  of  the  patient.  I  aided  these 
purges  by  glysters.  In  one  case,  where  a  griping 
and  black  stools  attended,  I  directed  injections  of 
lime  water  and  milk  to  be  used,  with  the  happiest 
effects. 

3.  I  gave  emetics  in  many  cases  with  advantage, 
but  never  while  the  pulse  was  full  or  tense. 


140  AN    ACCOUNT    OF    THE 

4.  Having  observed,  as  in  the  year  1802,  a 
spontaneous  moisture  on  the  skin  on  the  first  day 
of  the  disease,  in  several  cases,  I  was  led  to  assist 
this  disposition  in  nature  to  be  relieved  by  the 
pores,  by  means  of  sweating  remedies,  but  in  no 
instance  did  I  follow  it,  without  previous  evacua- 
tions from  the  blood-vessels  or  bowels  ;  for,  how- 
ever useful  the  intimations  of  nature  may  be  in 
acute  diseases,  her  efforts  should  never  be  trusted 
to  alone,  inasmuch  as  they  are  in  most  cases  too 
feeble  to  do  service,  or  so  violent  as  to  do  mischief. 
I  saw  one  death,  and  I  heard  of  another,  from  an 
exclusive  reliance  upon  spontaneous  sweats  in  the 
beginning  of  this  fever.  The  remedies  I  employed 
to  promote  this  evacuation  by  the  pores  were,  an 
infusion  of  the  eupatorium  perfoliatum  in  boiling 
water,  aided  by  copious  warm  drinks,  and  hot 
bricks  and  blankets,  applied  to  the  external  sur- 
face of  the  body.  The  eupatorium  sometimes 
sickened  the  stomach,  and  puked.  The  sweats 
were  intermitted,  and  renewed  two  or  three  times 
in  the  course  of  four  and  twenty  hours. 

5.  I  derived  great  advantage  from  the  application 
of  blisters  to  the  wrists,  before  the  system  descend- 
ed to  what  I  have  elsewhere  called,  the  blistering 
point.  This  was  on  the  second  and  third  days. 
My  design,  in  applying  them  thus  early,  was  to 


JBILIOUS    YELLOW    FEVER    OF    1803.       141 

attract  morbid  excitement  to  the  extremities,  and 
thereby  to  create  a  substitute  for  a  salivation. 
They  had  this  effect.  The  pain,  increase  of  fever, 
and  occasional  strangury,  which  were  produced  by 
them,  served  like  anchors  to  prevent  the  system 
being  drifted  and  lost,  by  the  concentration  of  mor- 
bid excitement  in  the  stomach  and  brain,  on  the 
fourth,  fifth,  sixth,  and  seventh  days  of  the  disease. 
It  gave  me  great  pleasure  to  find,  upon  revising 
Dr.  Home's  account  of  the  vellow  fever,  that  this 
mode  of  applying  blisters,  in  the  early  stage  of  the 
disease,  was  not  a  new  one.  He  often  applied 
them  in  the  first  stage  of  the  fever,  more  especially 
when  the  yellow  colour  of  the  skin  made  its  ap- 
pearance on  the  first  or  second  day.  By  the  ad- 
vice of  Dr.  Cheney,  of  Jamaica,  he  was  led  to  pre- 
fer them  to  the  thighs,  instead  of  the  trunk  of  the 
body,  or  the  legs  and  arms.  He  forbids  their  ever 
being  applied  below  the  calf  of  the  legs.  This  cau- 
tion is  probably  more  necessary  in  the  West- Indies 
than  in  the  United  States.  The  pain  and  inflam- 
mation excited  by  the  blisters  were  mitigated 
by  soft  poultices  of  bread  and  milk.  The  stran- 
gury soon  yielded  to  demulcent  drinks,  particu- 
larly to  flaxseed  tea. 

I  was  happy  in  not  being  compelled,  by  the  vio- 
lence or  obstinacy  of  this  fever,  to  resort  to  a  sali- 


142  AN    ACCOUNT    OF    THE 

vation  in  order  to  cure  it,  in  a  single  instance ;  the 
discharges  from  the  stomach  and  bowels,  and  from 
the  veins,  pores,  and  skin,  having  proved  sufficient 
to  convey  the  disease  out  of  the  system. 

Two  persons  recovered  this  year  who  had  the 
black  vomiting.  One  of  them  was  by  means  of 
large  quantities  of  brandy  and  volatile  alkali,  admi- 
nistered by  Dr.  John  Dorsey,  in  the  city  hospital ; 
the  other  was  by  means  of  lime  and  water  and  milk, 
given  by  an  intelligent  nurse  to  one  of  my  patients, 
during  the  interval  of  my  visits  to  her. 


/ 


From  the  history  which  has  been  given  of  the 
symptoms  of  this  fever;  from  the  less  force  of  medi- 
cine that  was  necessary  to  subdue  it ;  from  the  safe- 
ty and  advantage  of  blisters  in  its  early  stage ;  and 
from  the  small  proportion  which  the  deaths  bore  to 
the  number  of  those  who  were  affected,  being  sel- 
dom more  than  five  in  a  hundred  (including  all  the 
grades  and  forms  of  the  disease),  in  the  practice  of 
most  of  the  physicians,  it  is  evident  this  fever  was 
of  a  less  malignant  nature  than  it  had  been  in  most 
of  the  years  in  which  it  had  been  epidemic.  There 
was  one  more  circumstance  which  proved  its  dimi- 
nution of  violence,  and  that  was,  a  more  feeble 
operation  of  its  remote  cause.  In  the  year  1802, 
nearly  all  the  persons  who  were  affected  with  the 


BILIOUS    YELLOW    FEVER    OF    1803.       143 

fever  in  the  neighbourhood  of  Vine  and  Water- 
streets,  and  in  Water,  between  Walnut  and  Spruce- 
streets,  died.  This  year,  but  two  died  of  a  great 
number  who  were  sick  in  the  former,  and  not 
one  out  of  twelve  who  were  sick  in  the  latter  place. 
The  filth,  in  both  parts  of  the  city,  was  the  same 
in  both  years.  This  difference  in  the  violence  and 
mortality  of  the  fever  was  probably  occasioned  by  a 
less  concentrated  state  of  the  miasmata  which  pro- 
duced it,  or  by  the  co-operation  of  a  less  inflamma- 
tory constitution  of  the  atmosphere. 

The  yellow  fever  was  epidemic,  during  the  sum- 
mer and  autumn  of  this  year,  in  New- York,  and 
in  Alexandria,  in  Virginia.  In  the  latter  place. 
Dr.  Dick  has  informed  the  public,  it  was  derived 
from  domestic  putrefaction. 


AN 


j. 


\CCOUNT  OF  SPORADIC  CASES 


OF 


TELLOW  FEVER, 


AS   THEY 


APPEARED  IN  PHILADELPHIA, 


IN   1804, 


VOL.  IV* 


AN  ACCOUNT,  &c< 


THE  month  of  January  was  marked  by- 
deep  snows,  rain,  clear  and  cold  weather,  and  by 
the  general  healthiness  of  the  city. 

In  February  there  fell  a  deep  snow,  which  was 
followed  by  several  very  cold  days.  There  was 
likewise  a  fall  of  snow  in  March,  which  was  suc- 
ceeded by  an  uncommon  degree  of  cold.  Catarrhs 
and  bilious  pleurisies  were  very  common  during 
both  these  months. 

In  the  beginning  of  April,  the  weather  was  cold 
and  rainy.  There  were  but  few  signs  of  vegeta- 
tion before  the  15th  of  the  month.  Bilious  pleuri- 
sies were  still  the  principal  diseases  which  prevailed 
in  the  citv. 


148       AN    ACCOUNT    OF    SPORADIC    CASES 

The  month  of  May  was  wet,  cool,  and  healthy. 

In  June,  the  winds  were  easterly,  and  the  wea- 
ther rainy.  The  crops  of  grass  were  luxuriant. 
It  was  remarked,  that  the  milk  of  cows  that  fed 
upon  this  grass  yielded  less  butter  than  usual,  and 
that  horses  that  fed  upon  it,  sweated  profusely  with 
but  little  exercise.  On  the  third  of  the  month,  I 
was  called  upon  by  Dr.  Physick  to  visit  his  father, 
who  was  ill  with  a  bilious  fever.  He  died  on  the 
seventh,  with  a  red  eye,  hiccup,  and  black  vomit- 
ing. 

Four  persons  had  the  yellow  fever  in  the  month 
of  July.  One  of  them  was  in  Fourth- street,  be- 
tween Pine  and  Lombard- streets,  another  was  in 
Fifth-street,  between  Race  and  Vine-streets,  both  of 
whom  recovered.  The  remaining  two  were  in  the 
Pennsylvania  hospital,  both  of  whom  died.  Remit- 
ting and  intermitting  fevers  were  likewise  common 
in  this  month. 

In  August,  those  fevers  assumed  a  chronic  form. 
During  this  month,  there  died  an  unusual  number 
of  children  with  the  cholera  morbus. 

The  city  was  uncommonly  healthy  in  Septem- 
ber.    A  storm  of  wind  and  rain,  from  the  south- 


OJF    YELLOW    FEVER    IN    1804.  149 

cast,  proved  destructive  to  the  crops  of  cotton  this 
month,  on  the  sea  coast  of  South- Carolina. 

In  October,  intermittents  were  very  common 
between  Eighth-street  and  Schuylkill.  One  case 
of  yellow  fever  came  under  my  care,  in  conjunc- 
tion with  Dr.  Gallaher,  on  the  western  banks  of 
that  river. 

While  Philadelphia  and  all  the  cities  of  the  Unit- 
ed States  (Charleston  excepted)  were  thus  exemp- 
ted from  the  yellow  fever  as  an  epidemic,  the 
western  parts  of  all  the  middle,  and  several  of  the 
southern  states,  were  visited  with  the  bilious  fever, 
in  all  its  different  forms.  In  Delaware  county,  in 
the  state  of  New- York,  at  Mill  river,  in  Connecti- 
cut, and  in  several  of  the  middle  counties  of  Penn- 
sylvania, it  prevailed  in  the  form  of  a  yellow  fever. 
In  other  parts  of  the  United  States,  it  appeared 
chiefly  as  a  highly  inflammatory  remittent.  It  was 
so  general,  that  not  only  whole  families,  but  whole 
neighbourhoods  were  confined  by  it.  Many  suf- 
fered from  the  want  of  medical  advice  and  nursing, 
and  some  from  the  want  of  even  a  single  attendant. 
In  consequence  of  the  general  prevalence  of  this 
fever  in  some  parts  of  Pennsylvania,  the  usual  la- 
bours of  the  season  were  suspended.  Apples  fell 
and  perished  upon  the  ground ;  no  winter  grain  was 


150  AN   ACCOUNT  OF  SPORADIC   CASES,  &C. 

sowed ;  and  even  cows  passed  whole  days  and  nights 
without  being  milked. 

The  mortality  of  this  fever  was  considerable, 
where  those  distressing  circumstances  took  place. 
In  more  favourable  circumstances,  it  yielded  to  early 
depletion,  and  afterwards  to  the  bark.  Relapses 
were  frequent,  from  premature  exposure  to  the  air. 
Those  only  escaped  them  who  had  been  salivated, 
by  accident  or  design,  for  the  cure  of  the  fever. 

This  disease  was  observed  very  generally  to  pre- 
vail most  in  high  situations,  which  had  been  for 
years  distinguished  for  their  healthiness,  while  the 
low  grounds,  and  the  banks  of  creeks  and  rivers, 
were  but  little  affected  by  it.  The  unusual  quan- 
tity of  rain,  which  had  fallen  during  the  summer 
months,  had  produced  moisture  in  the  former 
places,  which  favoured  putrefaction  and  exhalation, 
while  both  were  prevented,  in  the  latter  places,  by 
the  grounds  being  completely  covered  with  water. 


AN  ACCOUNT 


OF    THE 


BILIO  US  TELL  OW  FE  VER, 


AS   IT 


APPEARED  IN  PHILADELPHIA, 

IN  THE  YEAR   1805. 


AN  ACCOUNT,  &c. 


FOR  a  history  of  the  uncommonly  cold  and 
tempestuous  winter  of  1804  and  1805,  the  reader 
is  referred  to  the  Account  of  the  Climate  of  Penn- 
sylvania, in  the  first  volume  of  these  Inquiries  and 
Observations. 

During  the  months  of  January,  February,  and 
March,  there  were  a  number  of  bilious  catarrhs  and 
pleurisies. 

On  the  7th  of  April,  I  visited  a  patient  in  the  yel- 
low fever  with  Dr.  Stewart.  He  was  cured,  chiefly 
by  copious  bleeding. 

The  weather  was  rainy  in  May.  After  the  mid- 
dle of  June,  and  during  the  whole  month  of  July, 
there  fell  no  rain.      The  mercury  in  Fahrenheit 

VOL.  iv.  u 


154  AN   ACCOUNT  OF    THE 

fluctuated,  for  ten  days,  between  90°  and  94°,  dur- 
ing this  month.  The  diseases  which  occurred  in 
it  were  cholera  infantum,  dysenteries,  a  few  com- 
mon bilious,  and  eight  cases  of  yellow  fever. 
Three  of  the  last  were  in  Twelfth,  between  Locust 
and  Walnut-streets,  and  were  first  visited,  on  the 
14th  and  15th  of  the  month,  by  Dr.  Hartshorn,  as 
out-patients  of  the  Pennsylvania  hospital.  Two  of 
them  were  attended,  about  a  week  afterwards,  by 
Dr.  Church,  in  South wark,  and  the  remaining  three 
by  Dr.  Rouisseau  and  Dr.  Stewart,  in  the  south 
end  of  the  city. 

On  the  third  of  August,  there  fell  a  heavy  shower 
of  rain,  but  the  weather,  during  the  remaining  part 
of  the  month,  was  warm  and  dry.  The  pastures 
were  burnt  up,  and  there  was  a  great  deficiency  of 
summer  vegetables  in  the  neighbourhood  of  Phila- 
delphia. The  water  in  the  Schuylkill  was  lower 
by  three  inches  than  it  had  been  in  the  memory  of 
a  man  of  70  years  of  age,  who  had  lived  constantly 
within  sight  of  it. 

In  September,  a  number  of  cases  of  yellow  fever 
appealed   in   Southwark*,   near   Catharine-street. 

*  This  extensive  district  is  continued,  from  the  city  of 
Philadelphia,  along  the  Delaware*  but  is  not  subject  to  itfs 
government. 


BILIOUS    YELLOW    FEVER    OF     1805.       155 

They  were  readily  traced  to  a  large  bed  of  oysters, 
which  had  putrifitd  on  Catharine -street  wharf,  and 
which  had  emitted  a  most  offensive  exhalation 
throughout  the  whole  neighbourhood,  for  several 
weeks  before  the  fever  made  its  appearance.  This 
exhalation  proved  fatal  to  a  number  of  cats  and 
dogs,  and  it  now  became  obvious  that  the  two  cases 
of  yellow  fever,  that  were  attended  by  Dr.  Church, 
in  the  month  of  July,  were  derived  from  it.  .  An 
attempt  was  made  to  impose  a  belief  that  they  were 
taken  by  contagion  from  a  ship  at  the  lazaretto, 
which  had  lately  arrived  from  the  West- Indies,  but  a 
careful  investigation  of  this  tale  proved,  that  neither 
of  the  two  subjects  of  the  fever  had  been  on  board 
that,  nor  any  other  ship,  then  under  quarantine. 

The  fever  prevailed  during  the  whole  of  this 
month  in  South wark.  A  few  cases  of  it  appeared 
in  the  city,  most  of  which  were  in  persons  who  had 
resided  in,  or  visited  that  district.  Ii  was  brought 
on  by  weak  exciting  causes  in  South  wark,  but  the 
cases  which  originated  in  the  city,  required  strong 
exciting  causes  to  produce  them. 

A  heavy  rain,  accompanied  with  a  good  deal  of 
wind,  on  the  :L8th  of  September,  and  a  frost  on  the 
night  of  the  7th  of  October,  gave  a  considerable 
check  to  the  fever. 


156  AN     ACCOUNT    OF    THE 

But  few  cases  of  it  came  under  my  care.  Hav- 
ing perceived  the  same  disposition  in  nature  to  re- 
lieve herself  by  the  pores,  that  I  observed  in  the 
years  1802  and  1803,  my  remedies  were  the  same 
as  in  the  latter  year,  and  attended  with  the  same 
success.  Dr.  Caldwell  and  Dr.  Stewart,  whose 
practice  was  extensive  in  Southwark,  informed  me, 
those  remedies  had  been  generally  successful  in 
their  hands. 

The  only  new  medicine  that  the  experience  of 
this  year  suggested  in  this  disease,  was  for  one  of 
its  most  distressing  and  dangerous  symptoms,  that 
is,  the  vomiting  which  occurs  in  its  second  stage. 
Dr.  Physick  discovered,  that  ten  drops  of  the  spirit 
of  turpentine,  given  every  two  hours,  in  a  little  mo- 
lasses, or  syrup,  or  sweet  oil,  effectually  checked  it 
in  several  instances,  in  patients  who  afterwards  re- 
covered. It  was  administered  with  equal  success 
in  a  case  which  came  under  my  care,  after  an  ab- 
sence of  pulse,  and  a  coldness  of  the  extremities 
had  taken  place.  Dr.  Church  informed  me  that 
he  gave  great  relief  to  the  sick  in  the  city  hospital, 
by  this  medicine,  by  prescribing  it  in  glysters,  as 
well  as  by  the  mouth,  in  distressing  affections  of 
the  stomach  and  bowels. 


BILIOUS    YELLOW    FEVER    OF    1805.       157 

Dr.  Stewart  observed  that  all  those  persons  who 
had  been  affected  by  the  yellow  fever  in  former 
years,  had  mild  remittents  in  the  same  situations 
that  others  had  the  prevailing  epidemic  in  a  malig- 
nant form. 

In  one  of  four  bodies  the  doctor  examined,  he 
found  six,  and  in  another  three  intussusceptions  of 
the  intestines,  without  any  signs  of  inflammation. 
He  discovered  the  common  marks  of  disease  from 
this  fever  in  other  parts  of  those  bodies. 

The  deaths  from  this  fever  amounted  to  between 
three  and  four  hundred.     They  would  probably 
have  been  more  numerous,  had  not  those  families 
who  were  in  competent  circumstances  fled  into  the 
country,  and  had  not  the  poor  been  removed,  by 
the  board  of  health,  from  the  infected  atmosphere 
of  Southwark,  to  tents  provided  for  them  in  the 
neighbourhood  of  the  city  ;  and  they  would  proba- 
bly have  been  fewer,  considering  the  tractable  na- 
ture of  the  disease,  when  met  by  suitable  remedies 
in  its  early  stage,  had  not  the  sick  concealed  their 
indisposition,  in  many  instances,  for  two  or  three 
days,  lest  they  should  •  be  dragged  to  the  city  hos- 
pital, or  have  centinels  placed  at  their  doors,  to  pre- 
vent any  communication   with  their  friends  and 
neighbours.     While  these  attempts  were  made  to 


158  AN    ACCOUNT    OF    THE 

check  the  progress  of  the  fever,  it  did  not  escape 
the  notice  of  many  of  the  citizens  of  Philadelphia, 
that  not  a  single  instance  occurred  of  its  being  com- 
municated by  contagion,  in  any  of  the  families  in 
the  city,  in  which  persons  had  sickened  or  died 
with  it,  and  that  while  the  sick  were  deprived  of 
the  kind  offices  of  their  friends  and  neighbours,  lest 
they  should  be  infected,  physicians,  and  the  mem- 
bers of  the  board  of  health,  passed  by  the  guards 
every  day,  in  their  visits  to  the  same  sick  people, 
and  afterwards  mixed  with  their  fellow-citizens, 
in  every  part  of  the  city,  without  changing  their 
clothes. 

The  yellow  fever  appeared  early  in  the  season  in 
New- Haven,  in  Connecticut,  and  in  Providence,  on 
Rhode  Island,  in  both  of  which  places  it  was  de- 
rived from  putrid  exhalation,  and  was  speedily  and 
effectually  checked  by  removing  the  healthy  persons 
who  lived  in  its  neighbourhood  to  a  distance  from 
it.  Several  sporadic  cases  of  it  occurred  dur- 
ing the  autumn  in  Gloucester  county,  in  New- 
Jersey,  and  in  Mifflin  and  Chester  counties,  in 
Pennsylvania.  It  was  epidemic  in  New- York  at 
the  same  time  it  prevailed  in  South wark  and  Phi- 
ladelphia. The  following  extract  of  a  letter  from 
the  health  officer  of  New- York,   to  one   of  his 


BILIOUS    YELLOW    FEVER    OF    1805.        159 

friends,  contains  a  satisfactory  proof  that  it  was  not. 
in  that  city,  an  imported  disease. 

Quarantine  ground,  Sept,  7. 

I  most  sincerely  and  tenderly  deplore  the  unfor- 
tunate situation  of  our  city.  What  do  people  say 
now  of  the  origin  of  the  disease  ?  You  may  state, 
for  the  information  of  those  who  wished  to  be  in- 
formed, that  not  a  single  vessel,  on  board  of  which 
a  person  has  been  sick  with  fever  of  any  kind,  or 
on  board  of  which  any  person  has  died  with  any 
disease,  while  in  the  West- Indies,  or  on  the  voy- 
age home,  has  ever  gone  up  to  the  city  during  this 
whole  season.  This  we  know,  and  this  we  vouch 
for ;  and  farther  state,  that  all  the  cases  of  fever 
that  have  come  down  as  from  the  city,  have  been 
all  people  of,  and  belonging  to  the  city,  and  uncon- 
nected with  the  shipping,  excepting  one,  a  sailor, 
who  had  no  connection  with  any  foul  vessel.  There 
is  not  a  shadow  of  proof  or  suspicion  that  can  at- 
tach to  the  health- office,  or  to  infected  vessels,  this 
season.  I  am,  &x. 

JOHN  R.  B.  RODGERS. 

Having  concluded  the  history  of  the  bilious  yel- 
low fever,  as  it  has  appeared  in  eleven  successive 
years,  since  1793,  as  an  epidemic,  or  in  sporadic 


160  AN    ACCOUNT,    &C. 

cases,  I  shall  proceed  next  to  enumerate  all  the 
sources  of  that  fever,  as  well  as  all  the  other  usual 
forms  of  the  summer  and  autumnal  disease  of  the 
United  States,  and  afterwards  mention  the  means 
of  preventing  them. 


AN  INQUIRY 


INTO 


THE  VARIOUS  SOURCES 

OF    THE    USUAL    FORMS    OF 

SUMMER  QT  AUTUMNAL   DISEASE 

IN  THE  UNITED  STATES, 

AND    THE    MEANS    OF    PREVENTING     THEM. 


VOL.   IV.  X 


AN  INQUIRY,  &c. 


THE  business  of  the  following  inquiry  is, 

I.  To  enumerate  the  various  sources  of  the  usual 
forms  of  the  summer  and  autumnal  disease  in  the 
United  States.     And, 

II.  To  mention  the  means  of  preventing  them. 

To  render  the  application  of  those  means  as  ex- 
tensive as  possible,  it  will  be  proper  to  mention, 
under  the  first  head,  all  those  sources  of  summer 
and  autumnal  disease,  which  have  been  known  to 
produce  it  in  other  countries,  as  well  as  in  the 
United  States.     They  are,    . 

1.  Exhalations  from  marshes.  These  are  sup- 
posed to  be  partly  of  a  vegetable,  and  partly  of  an 
animal  nature.  They  are  derived  from  the  shores 
of  creeks  and  mill  ponds,  as  well  as  from  low  and 
wet  grounds ;  also  from  the  following  vegetable 
substances  in  a  state  of  putrefaction. 


164  ON    THE    SOURCES    OF 

2.  Cabbage.  A  malignant  fever  was  produced 
at  Oxford,  by  a  putrid  heap  of  this  vegetable  some 
years  ago,  which  proved  fatal  to  many  of  the  inha- 
bitants, and  to  several  of  the  students  of  the  univer- 
sity at  that  place. 

3.  Potatoes.  Nearly  a  whole  ship's  crew  pe- 
rished at  Tortola,  by  removing  from  her  hold,  a 
quantity  of  putrid  potatoes. 

4.  Pepper. 

5.  Indian  meal. 

6.  Onions. 

7.  Mint. 

8.  Anise  and  caraway  seeds,  confined  in  the 
hold  of  a  ship. 

9.  Coffee.  "  About  the  time,"  savsDr.  Trot- 
ter,  "  when  notice  was  taken  of  the  putrefying 
coffee  on  the  wharf  at  Philadelphia,  in  the  year 
1793,  a  captain  of  a  man  of  war,  just  returned  from 
the  Jamaica  station,  informed  me,  that  several  ves- 
sels laden  with  the  same  produce  came  to  Kingston, 
from  St.  Domingo.     During  the  distracted  state 


SUMMER    AND    AUTUMNAL    DISEASE.     165 

of  that  colony,  this  article,  with  other  productions, 
had  been  allowed  to  spoil  and  ferment.  The  evo- 
lution of  a  great  quantity  of  fixed  air,  or  carbonic 
acid  gas,  was  the  consequence  ;  and  in  these  ves- 
sels, when  opening  the  hatchways,  such  was  its  con- 
centrated state,  that  the  whole  of  the  crew,  in  some 
of  them,  were  found  dead  on  the  deck.  A  pilot 
boarded  one  of  them  in  this  condition,  and  had 
nearly  perished  himself*." 

10.  Chocolate  shells. 

11 .  Cotton  which  had  been  wetted  on  board  of  a 
vessel  that  arrived  in  New- York,  a  few  years  ago, 
from  Savannah,  in  Georgia. 

12.  Hemp,  flax,„and  straw. 

13.  The  canvas  of  an  old  tent. 

14.  Old  books,  and  old  paper  money,  that  had 
been  wetted,  and  confined  in  close  rooms  and  clo- 
sets. 

15.  The  timber  of  an  old  house.  A  fever  pro- 
duced by  this  cause  is  mentioned  by  Dr.  Haller,  in 
his  Bibliotheca  Medicine. 

*  Medicine  Nautica,  p.  324. 


166  ON    THE    SOURCES    OF 

16.  Qreen  wood  confined  in  a  close  cellar  during 
the  summer  months.  A  fever  from  this  cause  was 
once  produced  in  this  city,  in  a  family  that  was  at- 
tended by  the  late  Dr.  Cadwallader. 

17.  The  green  timber  of  a  new  ship.  Captain 
Thomas  Bell  informed  me,  that  in  a  voyage  to  the 
East- Indies,  in  the  year  1784,  he  lost  six  of  his  men 
with  the  scurvy,  which  he  supposed  to  be  derived 
wholly  from  the  foul  air  emitted  by  the  green  tim- 
ber of  his  ship.  The  hammocks  which  were  near 
the  sides  of  the  ship  rotted  during  the  voyage,  while 
those  which  were  suspended  in  the  middle  of  the 
ship,  retained  their  sound  and  natural  state.  This 
scurvy  has  been  lately  proved  by  Dr.  Claiborne, 
in  an  ingenious  inaugural  dissertation,  published 
in  Philadelphia,  in  the  year  1798,  to  be  a  mis- 
placed state  of  malignant  fever.  Dr.  Lind  mentions 
likewise  the  timber  of  new  ships  as  one  of  the 
sources  of  febrile  diseases.  The  timber  of  soldiers' 
huts,  and  of  the  cabins  of  men  who  follow  the  bu- 
siness of  making  charcoal  in  the  woods,  often  pro- 
duce fevers,  as  soon  as  the  bark  begins  to  rot  and 
fall  from  them,  which  is  generally  on  the  second 
year  after  they  are  erected.  Fevers  have  been  ex. 
cited  even  by  the  exhalation  from  trees,  that  have 
been  killed  by  being  girdled  in  an  old  field. 


SUMMER    AND    AUTUMNAL    DISEASE.     167 

18.  The  stagnating  air  of  the  hold  of  a  ship. 

19.  Bilge  water. 

20.  Water  that  had  long  been  confined  in  hogs* 
iieads  at  sea. 

#1.  Stagnating  rain  water. 

22.  The  stagnating  air  of  close  cellars. 

23.  The  matters  which  usually  stagnate  in  the 
gutters,  common  sewers,  docks,  and  alleys  of  ci- 
ties, and  in  the  sinks  of  kitchens.  A  citizen  of 
Philadelphia,  who  had  a  sink  in  his  kitchen,  lost  a 
number  of  cats  and  dogs  by  convulsions.  At 
length  one  of  his  servants  was  affected  with  the 
same  disease.  This  led  him  to  investigate  the 
cause  of  it.  He  soon  traced  it  to  his  sink.  By 
altering  its  construction,  so  as  to  prevent  the  es- 
cape of  noxious  air  from  it,  he  destroyed  its  un- 
wholesome quality,  so  that  all  his  domestics  lived 
in  good  health  in  his  kitchen  afterwards. 

24.  Air  emitted  by  agitating  foul  and  stagnating 
water.  Dr.  Franklin  was  once  infected  with  an 
intermitting  fever  from  this  cause. 


168  ON    THE    SOURCES    OF 

25.  A  duck  pond.  The  children  of  a  family  in 
this  city  were  observed,  for  several  successive 
years,  to  be  affected  with  a  bilious  remitting  fever. 
The  physician  of  the  family,  Dr.  Phineas  Bond, 
observing  no  other  persons  to  be  affected  with  the 
same  fever  in  the  neighbourhood,  suspected  that 
it  arose  from  some  local  cause.  He  examined 
the  yard  belonging  to  the  house,  where  he  found 
an  offensive  duck  pond.  The  pond  was  filled  with 
earth,  and  the  family  were  afterwards  free  from  an 
annual  bilious  fever. 

26.  A  hog- stye  has  been  known  to  produce  vio- 
lent bilious  fevers  throughout  a  whole  neighbour- 
hood in  Philadelphia. 

27.  Weeds  cut  down,  and  exposed  to  heat  and 
moisture  near  a  house. 

Fevers  are  less  frequently  produced  by  putrid 
animal,  than  by  putrid  vegetable  matters.  There 
are,  however,  instances  of  their  having  been  gene-; 
rated  by  the  following  animal  substances  in  a  state 
of  putrefaction. 

1 .  Human  bodies  that  have  been  left  unburied 
upon  a  field  of  battle. 


SUMMER    AND    AUTUMNAL    DISEASE.      169 

2.  Salted  beef  and  pork. 

3.  Locusts. 

4.  Raw  hides  confined  in  stores,  and  in  the  holds 
of  ships. 

5.  A  whale  thrown  upon  the  sea  shore  in  Hol- 
land. 

6.  A  large  bed  of  oysters.  The  malignant  fe- 
vers which  prevailed  in  Alexandria,  in  Virginia,  in 
1803,  and  in  South wark,  adjoining  Philadelphia, 
in  the  year  1805,  were  derived  from  this  cause*. 

7.  The  entrails  of  fish.     And, 

8.  Privies.  The  diarrhoea  and  dysentery  are 
produced,  oftener  than  any  other  form  of  sum- 
mer and  autumnal  disease,  by  the  foe  tor  of  privies. 
During  the  revolutionary  war,  an  American  regi- 

*  It  has  been  a  common  practice  with  many  families,  in 
New- York  and  Philadelphia,  for  several  years  past,  to  lay  in 
a  winter  store  of  oysters  in  their  cellars  in  the  fall  of  the 
year.  May  not  a  part  of  these  oysters,  left  in  these  cellars 
from  forgetfulness,  or  from  being  unfit  for  use,  become,  by 
putrifying  there,  the  cause  of  malignant  fevers  in  the  siufcs 
ceeding  summer  and  autumn  ? 

VOL.   IV.  Y 


170  ON    THE    SOURCES    OF 

ment,  consisting  of  600  men,  were  affected  with  a 
dysentery,  from  being  encamped  near  a  large  mass 
of  human  faeces.  The  disease  was  suddenly  check- 
ed by  removing  their  encampment  to  a  distance 
from  it.  Five  persons  in  one  family  were  affected 
with  the  yellow  fever  in  Philadelphia,  in  1805,  who 
lived  in  a  house  in  which  a  privy  in  the  cellar  emit- 
ted a  most  offensive  smell.  No  one  of  them  had 
been  exposed  to  the  foul  air  of  South wark,  in  which 
the  fever  chiefly  prevailed  in  the  autumn  of  that 
year.  Three  of  them  sickened  at  the  same  time, 
which  obviated  the  suspicion  of  the  disease  being 
produced  by  contagion. 

There  are  several  other  sources  of  malignant  fe- 
vers besides  those  which  have  been  mentioned. 
They  are,  exhalations  from  volcanoes,  wells,  and 
springs  of  water  ;  also  flesh*,  fish,  and  vegetables, 

*  The  following  fact,  communicated  to  me  by  Mr.  Sa- 
muel Lyman,  a  member  of  congress  from  the  state  of  Mas- 
sachusetts, shows  the  importance  of  attending  to  the  condi- 
tion of  butchers'  meat  in  our  attempts  to  prevent  malignant 
fevers. 

A  farmer  in  New-Hampshire,  who  had  overheated  a  fat 
ox  by  excessive  labour  in  the  time  of  harvest,  perceiving 
him  to  be  indisposed,  instantly  killed  him,  and  sent  his  flesh 
to  a  neighbouring  market.  Of  twenty- four  persons  who  ate 
of  this  flesh,  fifteen  died  in  a  few  days.      The  fatal  disease 


SUMMER    AND    AUTUMNAL    DISEASE.      171 

eaten  in  a  putrid  state ;  but  these  seldom  act  in 
any  country,  and  two  of  them  only,  and  that  rarely, 
in  the  United  States. 

The  usual  forms  of  the  disease  produced  by  mi- 
asmata from  the  sources  of  them  which  have  been 
enumerated  are, 

1.  Malignant  or  bilious  yellow  fever. 

2.  Inflammatory  bilious  fever. 

3.  Mild  remittent. 

4.  Mild  intermittent. 

5.  Chronic,  or  what  is  called  nervous  fever. 

6.  Febricula. 

7.  Dysentery* 

8.  Colic. 

9.  Cholera  morbus. 

produced  by  this  aliment  fell,  with  its  chief  force,  upon  the 
stomach  and  bowels. 


172  ON    THE    SOURCES    OF 

10.  Diarrhoea. 

In  deriving  all  the  above  forms  of  disease  from 
miasmata,  I  do  not  mean  to  insinuate,  that  sporadic 
cases  of  each  of  them  are  not  produced  by  other 
causes. 

In  designating  them  by  a  single  name,  I  commit 
no  breach  upon  the  ancient  nomenclature  of  medi- 
cine. The  gout  affects  not  only  the  blood-vessels 
and  bowels,  but  every  other  part  of  the  body,  and 
yet  no  writer  has,  upon  that  account,  distinguished 
it  by  a  plural  epithet. 

The  four  last  of  the  forms  of  disease,  that  have 
been  mentioned,  have  been  very  properly  called  in- 
testinal states  of  fever.  They  nearly  accord,  in 
their  greater  or  less  degrees  of  violence  and  danger, 
with  the  first  four  states  of  fever  which  occupy  the 
blood-vessels,  and  in  the  order  in  which  both  of 
them  have  been  named.  I  shall  illustrate  this  re- 
mark by  barely  mentioning  the  resemblance  of  the 
yellow  fever  to  the  dysentery,  in  being  attended 
with  costiveness  in  its  first  stage,  from  a  suspended 
or  defective  secretion  or  excretion  of  bile,  and  in 
terminating  very  generally  in  death,  when  not  met 
by  the  early  use  of  depleting  remedies. 


SUMMER    AND    AUTUMNAL    DISEASE.     173 

The  variety  in  the  forms  and  grades  of  the  sum- 
mer and  autumnal  disease,  in  different  seasons,  and 
their  occasional  changes  into  each  other  in  the  same 
seasons,  are  to  be  sought  for  in  the  variety  of  the 
sensible  and  insensible  qualities  of  the  atmosphere, 
of  the  course  of  the  winds,  and  of  the  aliments  of 
different  years. 

II.  The  means  of  preventing  the  different  forms 
of  disease  that  have  been  mentioned,  come  next 
under  our  consideration. 

Happily  for  mankind,  Heaven  has  kindly  sent 
certain  premonitory  signs  of  the  most  fatal  of  them. 
These  signs  appear, 

I.  Externally,  in  certain  changes  in  previous  dis- 
eases, in  the  atmosphere,  and  in  the  animal  and 
vegetable  creation. 

II.  In  the  human  body. 

1.  The  first  external  premonitory  sign  that  I 
shall  mention  is,  an  unusual  degree  of  violence  in 
the  diseases  of  the  previous  year  or  season.  Many 
proofs  of  the  truth  of  this  remark  are  to  be  met 
with  in  the  works  of  Dr.  Sydenham.  It  has  been 
confirmed  in  Philadelphia,  in  nearly  all  her  malig- 


174        ON    THE    MEANS    OF    PREVENTING 

nant  fevers  since  the  year  1793.  It  would  seem  as 
if  great  and  mortal  epidemics,  like  the  planets,  had 
satellites  revolving  round  them,  for  they  are  not 
only  preceded,  but  accompanied  and  followed,  by 
diseases  which  appear  to  reflect  back  upon  them 
some  of  their  malignity.  But  there  is  an  excep- 
tion to  this  remark,  for  we  now  and  then  observe 
uncommon  and  general  healthiness,  before  the  ap- 
pearance of  a  malignant  epidemic.  This  was  the 
case  in  Philadelphia,  previously  to  the  fevers  of 
1798  and  1799.  I  have  ascribed  this  to  the  stimu- 
lus of  the  pestilential  miasmata  barely  overcoming 
the  action  of  weak  diseases,  without  being  power- 
ful enough  to  excite  a  malignant  fever. 

2.  Substances,  painted  with  white  lead,  and  ex- 
posed to  the  air,  suddenly  assuming  a  dark  colour; 
and  winds  from  unusual  quarters,  and  unusual  and 
long  protracted  calms,  indicate  the  approach  of  a 
pestilential  disease.  The  south  winds  have  blown 
upon  the  city  of  Philadelphia,  ever  since  1793, 
more  constantly  than  in  former  years.  A  smoki- 
ness  or  mist  in  the  air,  the  late  Dr.  Matthew  Wil- 
son has  remarked,  generally  precedes  a  sickly  au- 
tumn in  the  state  of  Delaware. 

3.  Malignant  and  mortal  epidemics  are  often  pre- 
ceded by  uncommon  sickness  and  mortality  among 


SUMMER    AND    AUTUMNAL    DISEASE.      175 

certain  birds  and  beasts.  They  have  both  appeared, 
chiefly  among  wild  pigeons  and  cats  in  the  United 
States.  The  mortality  among  cats,  previous  to  the 
appearance  of  epidemics,  has  been  taken  notice  of  in 
other  countries.  Dr.  Willan  says,  it  occurred  in 
the  city  of  London,  between  the  20th  of  March 
and  the  20th  of  April,  in  the  year  1797,  before  a 
sickly  season,  and  Dr.  Buneiva  says  it  preceded  a 
mortal  epidemic  in  Paris.  The  cats,  the  doctor 
remarks,  lose,  on  the  second  day  of  their  disease, 
the  power  of  emitting  electrical  sparks  from  their 
backs,  and,  when  thrown  from  a  height,  do  not,  as 
in  health,  fall  upon  their  feet*. 

4.  The  common  house  fly  has  nearly  disappear- 
ed from  our  cities,  moschetoes  have  been  multi- 
plied, and  several  new  insects  have  appeared,  just 
before  the  prevalence  of  our  late  malignant  epide- 
mics. 

5.  Certain  trees  have  emitted  an  unusual  smell ; 
the  leaves  of  others  have  fallen  prematurely  ;  sum- 
mer fruits  have  been  less  in  size,  and  of  an  inferior 
quality  ;  and  apples  and  pears  have  been  knotty,  in 
the  summers  previous  to  several  of  our  malignant 

*  Medical  Journal,  vol.  iv. 


176        ON    THE    MEANS    OF    PREVENTING 

■ 

autumnal  fevers.  Dr.  Ambrose  Parey  says,  an  un- 
usually rapid  growth  of  mushrooms  once  preceded 
the  plague  in  Paris. 

II.  The  premonitory  signs  of  an  approaching 
malignant  epidemic  in  the  human  body  are, 

1.  A  sudden  drying  up,  or  breaking  out  of  an 
old  sore  ;  fresh  eruptions  in  different  parts  of  the 
body  ;  a  cessation  of  a  chronic  disease,  or  a  conver- 
sion of  a  periodical  into  a  continual  disease.  Of 
this  there  were  many  instances  in  Philadelphia,  in 
the  year  1793. 

2.  A  peculiar  sallowness  of  the  complexion. 
This  was  observed  to  be  general  in  Philadelphia, 
previous  to  the  yellow  fever  of  1793.  Dr.  Dick 
informed  me,  that  he  had  observed  the  same  ap- 
pearance in  the  faces  of  the  people  of  Alexandria, 
accompanied  in  some  cases  with  a  yellowness  of 
the  eyes,  during  the  summer  of  1793,  and  previous 
to  the  appearance  of  a  violent  bilious  fever  on  the 
banks  of  the  Potowmac. 


3.  I  have  observed  one  or  more  of  the  following 
symptoms,  namely,  head-ach ;  a  decay,  or  increase 


SUMMER    AND    AUTUMNAL    DISEASE.     177 

of  appetite  ;  costiveness  ;  a  diminished  or  increased 
secretion  of  urine -,  a  hot  and  offensive  breath*; 
constant  sweats,  and  sometimes  of  a  foetid  nature, 
or  a  dry  skin ;  wakefulness,  or  a  disposition  to 
early  or  protracted  sleep ;  a  preternaturally  frequent 
pulse  ;  unusual  vivacity,  or  depression  of  spirits ; 
fatigue  and  sweats  from  light  exertions ;  hands, 
when  rubbed,  emitting  a  smell  like  hepar  sulphu- 
ris  ;  and,  lastly,  a  sense  of  burning  in  the  mouth; 
to  be  present  in  different  persons,  during  the  pre- 
valence of  our  malignant  epidemics. 


*  I  have  once  known  this  breath,  in  a  gentleman  who  had 
carried  the  seeds  of  the  yellow  fever  in  his  body  from  Phi- 
ladelphia into  its  neighbourhood,  create  sickness  at  the  sto- 
mach in  his  wife  ;  and  I  have  heard  of  an  instance  in  which 
a  person,  who  left  Philadelphia  when  highly  impregnated  with 
the  miasmata  of  the  same  fever,  creating  sickness  at  the  sto- 
mach in  four  or  five  persons  who  sat  at  the  same  table  with 
him  in  the  country.  None  of  the  above  persons  were  after- 
wards affected  by  the  fever.  In  an  anonymous  history  of 
the  plague  in  London,  in  the  year  1664,  in  the  possession  of 
the  author,  it  is  said,  the  breath  was  a  well-known  signal  of 
infection  to  persons  who  were  not  infected,  and  that  when- 
ever it  was  perceived,  individuals  and  companies  fled  from 
it.  The  sickness  in  the  above-mentioned  persons  was  simi- 
lar to  that  which  is  sometimes  excited  by  the  smell  of  a 
sore  leg,  or  a  gun-shot  wound,  upon  the  removal  of  its  first 
dressing.  It  does  not  produce  fever,  because  there  is  no 
predisposition  to  it. 

VOL.  IV.  Z 


178  ON     THE    MEANS    OF    PREVENTING 

The  means  of  preventing  the  different  forms  of 
our  summer  and  autumnal  disease  come  next  under 
our  consideration.  I  shall  first  mention  such  as 
have  been  most  effectual  in  guarding  against  its 
malignant  form,  and  afterwards  take  notice  of  such 
as  are  proper  in  its  milder  grades.  These  means 
naturally  divide  themselves  again,  „ 

I.  Into  such  as  are  proper  to  protect  individuals. 

II.  Such  as  are  proper  to  defend  whole  commu- 
nities from  the  disease.     And, 

III.  Such  as  are  proper  to  exterminate  it,  by  re- 
moving its  causes. 

I.  Of  the  means  of  protecting  individuals. 

Where  flight  is  practicable,  it  should  be  resorted 
to  in  every  case,  to  avoid  an  attack  of  a  malignant 
fever.  The  heights  of  Germantown  and  Darby 
have,  for  many  years,  afforded  a  secure  retreat  to  a 
large  number  of  the  citizens  of  Philadelphia,  from 
their  late  annual  epidemics.  It  were  to  be  wished 
our  governments  possessed  a  power  of  compelling 
our  citizens  to  desert  the  whole,  or  parts,  of  in- 
fected cities  and  villages.  In  this  way  the  yellow 
fever  was  suddenly  annihilated  in  Providence,  on 


SUMMER    AND    AUTUMNAL    DISEASE.      179 

Rhode- Island,  and  in  New- Haven,  in  Connecticut, 
in  the  year  1805.  But  the  same  power  should  ri- 
gorously prevent  the  removal  of  the  sick,  except  it 
be  that  class  of  them  which  have  neither  homes  nor 
friends.  The  less  the  distance  they  are  carried 
beyond  the  infected  atmosphere,  the  better.  The 
injury  sustained  by  conveying  them  in  a  jolting 
carriage,  for  two  or  three  miles,  has  often  been  pro- 
claimed in  the  reports  of  our  city  hospitals,  of  pa- 
tients being  admitted  without  a  pulse,  and  dying  a 
few  hours  afterwards; 

In  leaving  a  place  infected  by  miasmata,  care 
should  be  taken  not  to  expose  the  body  to  great 
cold,  heat,  or  fatigue,  for  eighteen  or  twenty  days, 
lest  they  should  excite  the  dormant  seeds  of  the 
disease  into  action. 

But  where  flight  is  not  enforced  by  law,  or  where 
it  is  not  practicable,  or  preferred,  safety  should  be 
sought  for  in  such  means  as  reduce  the  preternatu- 
ral tone  and  fulness  induced  in  the  blood-vessels 
by  the  stimulus  of  the  miasmata,  and  the  suppres- 
sion of  customary  secretions.     These  are, 

1.  A  diet,  accommodated  to  the  greater  or  less 
exposure  of  the  body  to  the  action  of  miasmata, 
and  to  the  greater  or  less  degrees  of  labour,  or  ex- 


180        ON    THE    MEANS    OF    PREVENTING 

ercise,  which  are  taken.  In  cases  of  great  expo* 
sure  to  an  infected  atmosphere,  with  but  little  exer- 
cise, the  diet  should  be  simple  in  its  quality,  and 
small  in  its  quantity.  Fresh  meats  and  wine  should 
be  avoided.  A  little  salted  meat,  and  Cayenne 
pepper  with  vegetables,  prevent  an  undue  languor 
of  the  stomach,  from  the  want  of  its  usual  cordial 
aliments.  The  less  mortality  of  the  yellow  fever 
in  the  French  and  Spanish  West- India  islands  than 
in  the  'British,  has  been  justly  attributed  to  the 
more  temperate  habits  of  the  natives  of  France  and 
Spain.  The  Bramins,  who  live  wholly  upon  ve- 
getables, escape  the  malignant  fevers  of  India,  while 
whole  regiments  of  Europeans,  who  eat  animal 
food,  die  in  their  neighbourhood.  The  people 
of  Minorca,  Dr.  Cleghorn  says,  who  reside  near 
gardens,  and  live  chiefly  upon  fruit  during  the  sum- 
mer, escape  the  violent  autumnal  fever  of  that 
island.  The  field  negroes  of  South- Carolina  owe 
their  exemption  from  bilious  fevers  to  their  living 
chiefly  upon  vegetables.  There  is  a  fact  which 
shows,  that  not  only  temperance,  but  abstinence 
bordering  upon  famine,  has  afforded  a  protection 
from  malignant  fevers.  In  a  letter  which  I  re- 
ceived a  few  months  ago,  from  the  Rev.  Thomas 
Hall,  chaplain  to  the  British  factory  at  Leghorn, 
containing  an  account  of  the  yellow  fever  which 
prevailed  in  that  city,  in  the  summer  and  autumn 


SUMMER    AND    AUTUMNAL    DISEASE.     181 

of  1804,  there  is  the  following  communication. 
*f  Of  the  rich,  who  live  in  large  airy  houses,  there 
died  but  four  persons  with  the  fever.  Of  the  com- 
modious,  who  live  comfortably,  but  not  affluenuy, 
there  died  ten.  Of  the  poor,  who  inhabited  small 
and  crowded  rooms,  in  the  dirty  and  confined  parts 
of  the  city,  there  died  nearly  seven  hundred.  But 
of  the  beggars,  who  had  scarcely  any  thing  to  eat, 
and  who  slept  half  naked  every  night  upon  hard 
pavements,  not  one  died."  From  the  reduced  and 
exhausted  state  of  the  system  in  these  people,  they 
were  incapable,  if  I  may  be  allowed  the  expression, 
of  the  combustion  of  fever.  Persons  reduced  by 
chronic  diseases,  in  like  manner,  often  escape  such 
as  are  acute.  S/x  French  ships  of  the  line  landed 
300  sick,  at  St.  Domingo,  while  the  yellow  fever 
prevailed  there  in  the  year  1745,  and  yet  no  one  of 
them  was  infected  by  it*. 

Where  the  body  is  exposed  to  miasmata,  and  a 
great  deal  of  exercise  taken  at  the  same  time, 
broths,  a  little  wine,  or  malt  liquors,  may  be  used 
with  the  fruits  and  garden  vegetables  of  the  season, 
with  safety  and  advantage.  The  change  from  a 
full  to  a  low  diet  should  be  made  gradually.  When 
made  suddenly,  it  predisposes  to  an  attack  of  the 
disease. 

*  Desportes,  vol.  i.  p.  140. 


1S2        ON    THE    MEANS    OF    PREVENTING 

2.  Laxative  medicines.  Hundreds,  perhaps 
thousands,  of  the  citizens  of  Philadelphia  were  in- 
debted for  their  preservation  from  the  yellow  fever 
to  the  occasional  use  of  a  calomel  pill,  a  few  grains 
of  rhubarb,  or  a  table- spoonful  of  sweet,  or  castor  oil, 
during  the  prevalence  of  our  late  pestilential  fevers. 
Even  the  air  of  Batavia  has  been  deprived  of  its 
poisonous  quality,  by  means  of  this  class  of  medi- 
cines. A  citizen  of  Philadelphia  asked  a  captain 
of  a  New- England  ship,  whom  he  met  at  that 
island,  how  he  preserved  the  whole  crew  of  his 
ship  in  health,  while  half  the  sailors  of  all  the  other 
ships  in  the  harbour  were  sick  or  dead.  He  in- 
formed him,  that  it  was  by  giving  each  of  them  a 
gentle  purge  of  sulphur  every  day. 

3.  A  plentiful  perspiration,  or  moderate  sweats, 
kept  up  by  means  of  warm  clothing  and  bed-clothes. 
The  excretion  which  takes  place  by  the  skin,  is  a 
discharge  of  the  first  necessity.  I  have  never 
known  an  instance  of  a  person's  being  attacked  by 
the  yellow  fever  in  whom  this  discharge  was  con- 
stant, and  equally  diffused  all  over  the  body.  Its 
effects  are  equally  salutary  in  preventing  the  plague. 
So  well  known  is  this  fact,  that  Mr.  Volney  informs 
us,  in  his  Travels  into  Egypt,  that  the  common 
salutation  at  Cairo,  during  the  prevalence  of  the 
plague,  is,  "  Do  you  sweat  freely  ?"    For  the  pur- 


SUMMER    AND    AUTUMNAL    DISEASE.      183 

pose  of  promoting  this  excretion,  flannel  shirts  or 
waistcoats  worn  next  to  the  skin  have  been  found 
more  useful  than  linen.  As  the  perspiration  and 
sweats,  which  are  thus  discharged  in  a  pestilential 
season,  are  often  unusual  in  their  quantity,  and  of 
a  morbid  quality,  clean  body-linen  or  flannel  should 
be  put  on  every  day,  and  where  this  is  not  practi- 
cable, that  which  has  been  worn  should  be  ex- 
changed every  morning  and  evening  for  that  which 
has  been  exposed  during  the  previous  day  and 
night,  in  a  dry  air. 

4.  Blood-letting.  In  addition  to  the  authorities 
of  Dr.  Haller  and  Dr.  Hodges,  mentioned  in  ano- 
ther place*,  in  favour  of  this  remedy,  I  shall  sub- 
join a  few  others.  Dr.  Mitchell,  in  his  Account 
of  the  Yellow  Fever  which  prevailed  in  Virginia, 
in  the  year  1741,  informs  us,  that  it  was  often  pre- 
vented in  persons  who  were  under  the  influence  of 
its  remote  cause,  by  the  loss  of  a  few  ounces  of 
blood.  It  was  formerly  a  practice  among  the  phy- 
sicians in  St.  Domingo,  to  bleed  whole  regiments 
of  troops  as  soon  as  they  arrived  from  France,  by 
which  means  they  were  preserved  from  the  malig- 
nant fever  of  the  island. 

*  Account  of  the  Yellow  Fever  in  17y3,  vol.  iii. 


184        ON    THE    MEANS    OF    PREVENTING 

During  the  short  visit  paid  to  this  city,  in  the  year 
1798,  by  Dr.  Borland,  a  respectable  physician  of  the 
British  army,  he  put  into  my  hands  the  following 
communication.  "  In  the  beginning  of  August, 
"  1797,  109  Dutch  artillery  arrived  at  Port  au 
"  Prince,  in  the  Bangalore  transport.  The  florid 
u  appearance  of  the  men,  their  cumbersome  cloth- 
"  ing,  and  the  season  of  the  year,  seemed  all  unfa- 
"  vourable  omens  of  the  melancholy  fate  we  pre- 
"  sumed  awaited  them.  It  was,  however,  thought 
"  a  favourable  opportunity,  by  Dr.  Jackson  and 
"  myself,  to  try  what  could  be  done  in  warding  off 
"  the  fever.  It  was  accordingly  suggested  to 
",  Monsieur  Conturier,  the  chief  surgeon  of  the 
"  foreign  troops,  and  the  surgeon  of  the  regiment, 
"  that  the  whole  detachment  should  be  blooded 
"  freely,  and  that,  the  morning  after,  a  dose  of  phy- 
"  sic  should  be  administered  to  every  man.  This 
11  was  implicitly  complied  with,  a  day  or  two  after, 
"  and  at  this  moment  in  which  I  write,  although 
"  a  period  of  four  months  has  elapsed,  but  two  of 
u  that  detachment  have  died,  one  of  whom  was  in  a 
"  dangerous  state  when  he  landed.  A  success  un- 
"  paralleled  during  the  war  in  St  Domingo  !  It  is 
"  true,  several  have  been  attacked  with  the  disease, 
"  but  in  those  the  symptoms  were  less  violent,  and 
"  readily  subsided  by  the  use  of  the  lancet. 


SUMMER    AND    AUTUMNAL    DISEASE.     185 

"  The  crew  of  the  Bangalore,  on  her  arrival  at 
"  Port  au  Prince,  consisted  of  twenty-eight  men. 
"  With  them  no  preventive  plan  was  followed.  In 
"  a  very  few  weeks  eight  died,  and  at  present,  of 
"  the  original  number,  but  fourteen  remain." 

All  these  depleting  remedies,  whether  used  sepa- 
rately or  together,  induce  such  an  artificial  debility 
in  the  system,  as  disposes  it  to  vibrate  more  rea- 
dily under  the  impression  of  the  miasmata.  Thus 
the  willow  rises,  after  bowing  before  a  blast  of 
wind,  while  the  unyielding  oak  falls  to  the  ground 
by  its  side.  It  is  from  the  similarity  of  the  natural 
weakness  in  the  systems  of  women,  in  the  West- 
Indies,  with  that  which  has  been  induced  by  the 
artificial  means  that  have  been  mentioned,  that  they 
so  generally  escape  the  malignant  endemic  of  the 
islands. 

A  second  class  of  preventives  of  malignant  fever 
are  such  as  obviate  the  internal  action  of  miasmata, 
by  exciting  a  general  or  partial  determination  to 
the  external  surface  of  the  body.     These  are, 

1.  The  warm  bath.  I  have  known  this  grateful 
remedy  used  with  success  in  our  city.  It  serves 
the  treble  purposes  of  keeping  the  skin  clean,  and 
the  pores  open,  and  of  defending  what  are  called 

vol.  iv.  2  a 


186        ON     THE    MEANS    OF    PREVENTING 

the  vital  organs  from  disease,  by  inviting  its  remote 
cause  to  the  external  surface  of  the  body. 

2.  The  cold  bath,  or  cold  water  applied  to  the 
external  surface  of  the  body.  Ulloa,  in  his  travels 
through  Cuba,  tells  us  the  Spaniards  make  it  a 
practice,  when  partially  wetted  by  the  rain,  to 
plunge  themselves,  with  their  wet  clothes  on,  into 
the  first  stream  of  water  the}*  meet  with  afterwards, 
by  which  means  they  avoid  taking  the  fever  of  the 
island.  Where  this  cannot  be  conveniently  done, 
the  peasants  strip  oil  their  clothes,  and  put  them 
under  a  shelter,  and  receive  showers  of  rain  upon 
their  naked  bodies,  and  thus  preserve  themselves 
from  the  fever.  Dr.  Baynard  has  left  it  upon  re- 
cord, in  his  treatise  upon  the  cold  bath,  that  those 
persons  who  lived  in  water-mills,  also  watermen, 
bargemen,  and  fishermen,  who  were  employed  up- 
on the  river,  and  in  dabbling  in  cold  water,  were 
rarely  affected  by  the  plague  in  London,  in  1665, 
and  that  but  two  persons  died  with  it  on  London 
bridge.  The  water  carriers  at  Cairo,  Mr.  Volney 
says,  uniformly  escape  the  plague  ;  and  Dr.  Chis- 
holm  informs  us,  that  those  negroes  in  Demarara 
who  go  naked,  and  are  thereby  disposed  not  to 
avoid  showers  of  rain,  are  never  affected  with  the 
fever  of  that  countrv. 


.SUMMER    AND    AUTUMNAL    DISEASE.     187 

3.  Washing  the  body,  every  morning  and  eve- 
ning, with  salt  water.  A  whole  ship's  crew  from 
Philadelphia  was  preserved  by  this  means  from  the 
yellow  fever,  some  years  ago,  in  one  of  the  West- 
India  islands,  while  a  large  proportion  of  the  crews 
of  several  ships,  that  lay  in  the  same  harbour,  pe- 
rished by  that  disease. 

4.  Anointing  the  body  with  oil.  The  natives 
of  Africa,  and  some  American  Indians,  use  this  pre- 
ventive with  success  during  their  sickly  seasons.  It 
has  lately  been  used,  it  is  said,  with  effect  in  pre- 
venting the  plague.  Its  efficacy  for  that  purpose 
was  first  suggested  by  no  oilman  having  died  of 
that  disease  during  four  years,  in  which  time 
100,000  people  perished  with  it  in  Egypt.  Oliver, 
in  his  Travels  into  that  country,  says  the  men  who 
make  and  sell  butter,  are  equally  fortunate  in  escap- 
ing it. 

5.  Issues,  setons,  and  blisters  belong  to  this  class 
of  preventives  of  malignant  and  bilious  fevers. 
Issues,  according  to  Parisinus,  Florentinus,  Fores- 
tus,  and  several  other  authors  quoted  by  Diemer- 
broeck,  have  prevented  the  plague  in  many  hundred 
instances.  Paraeus  says,  all  who  had  ulcers  from 
the  venereal  disease,  or  any  other  cause,  escaped  it. 
Dr.  Hodges  owed  his  preservation  from  the  plague 


188        ON    THE    MEANS    OF    PREVENTING 

in  London,  in  1665,  to  an  issue  in  his  leg.  He 
says  he  always  felt  a  slight  pain  in  it  when  he  went 
into  a  sick  room.  Dr.  Gallaher  ascribed  his 
escape  from  the  yellow  fever  of  1799  to  a  perpetual 
blister,  which  he  applied  to  his  arm  for  that  pur- 
pose. Dr.  Barton  favoured  me  with  the  sight  of 
a  letter  from  Dr.  James  Stevens,  dated  January  12, 
1801,  in  which  he  says  he  believed  Dr.  Beach 
(formerly  of  Connecticut)  had  been  preserved  from 
the  bilious  fever  by  a  seton  in  his  side.  He  adds 
further,  that  Dr.  Beach  had  been  called  to  attend 
the  labourers  at  the  Onandoga  salt  springs,  in  the 
state  of  New- York,  ninety-eight  of  whom  out  of  a 
hundred  had  the  bilious  fever.  Of  the  two  who 
escaped  it,  one  had  a  sore  leg,  the  other  what 
is  called  a  scald-head.  The  discharge  from  the 
sores  in  each  of  them,  as  well  as  from  the  doctor's 
issue,  was  more  copious  during  the  prevalence  of 
the  fever,  than  it  had  been  at  any  other  time. 

A  third  class  of  preventives  of  malignant  fever, 
are  such  as  excite  a  general  action,  more  powerful 
than  that  which  the  miasmata  are  disposed  to  cre- 
ate in  the  system,  or  an  action  of  a  contrary  nature. 
These  are, 

1.  Onions  and  garlic.  All  those  citizens  who 
used  these  vegetables  in  their  diet,  escaped  the  yel- 


SUMMER    AND    AUTUMNAL    DISEASE.     189 

low  fever  in  1793.  The  greater  exemption  of  the 
natives  of  France  from  this  disease,  wherever  they 
are  exposed  to  it,  than  of  the  inhabitants  of  other 
European  countries,  has  been  ascribed  in  part  to  the 
liberal  use  of  those  condiments  in  their  food.  The 
Jews,  it  has  been  said,  have  often  owed  to  them  their 
preservation  from  the  plagues  which  formerly  pre- 
vailed in  Europe.  It  is  probable  leeks  and  onions, 
which  to  this  day  form  a  material  part  of  the  diet 
of  the  inhabitants  of  Egypt,  were  cultivated  and 
eaten  originally  as  the  means  of  obviating  the 
plagues  of  that  country.  I  have  been  at  a  loss  to 
know  why  the  Author  of  Nature,  who  has  endowed 
these  vegetables  with  so  many  excellent  qualities 
for  diet  and  medicine,  should  have  accompanied 
them  with  such  a  disagreeable  smell.  Perhaps  the 
reason  was,  kindly  to  force  them  into  universal  use ; 
for  it  is  remarkable  their  smell  in  the  breath  is  im- 
perceptible to  those  who  use  them. 

2.  Calomel,  taken  in  such  small  doses  as  gently 
to  affect  the  gums.  It  preserved  most  of  the 
crew  of  a  Russian  ship  at  Plymouth,  in  the  year 
1777,  from  a  fever  generated  by  filth  in  her  hold. 
In  a  letter  which  I  received  from  Captain  Thomas 
Truxton,  in  the  year  1797,  he  informed  me,  that 
an  old  and  respectable  merchant  at  Batavia  had  as- 
sured him,  he  had  been  preserved  in  good  health 


190        ON    THE    MEANS    OF    PREVENTING 

by  calomel,  taken  in  the  way  that  has  been  men- 
tioned, during  the  sickly  seasons,  for  upwards  of 
thirty  years.  The  mortality  of  the  fevers  of  that 
island  may  easily  be  conceived  of,  when  I  add,  on 
the  authority  of  a  physician  quoted  in  Sir  George 
Staunton's  Account  of  his  Embassy  to  China,  that 
one  half  of  all  new  comers  die  there  on  the  first 
year  of  their  arrival. 

Our  principal  dependence  should  be  placed  up- 
on those  two  preventives  under  this  head.  There 
are  several  others  which  have  been  in  common  use, 
some  of  which  I  believe  are  hurtful,  and  the  rest 
are  of  feeble,  or  doubtful  efficacy.     They  are, 

3.  Wine  and  ardent  spirits.  They  both  prevent 
a  malignant  fever,  only  when  they  excite  an  action 
in  the  system  above  that  which  is  ordinarily  ex- 
cited by  the  miasmata  of  the  fever ;  but  this  cannot 
be  done  without  producing  intoxication,  which,  to 
be  effectual,  must  be  perpetual ;  for  the  weakness 
and  excitability,  which  take  place  in  the  intervals 
of  drunkenness,  predispose  to  the  disease.  Agree- 
ably to  this  remark,  I  observed  three  persons,  who 
were  constantly  drunk,  survive  two  of  our  most 
fatal  epidemics,  while  all  those  persons  who  were 
alternately  drunk  and  sober,  rarely  escaped  an  at- 


SUMMER    AND    AUTUMNAL    DISEASE.      191 

tack  of  the  fever.     In  most  of  them,  it  terminated 
in  death. 

4.  Tobacco.  Many  hundreds  of  the  citizens  of 
Philadelphia  can  witness,  that  no  benefit  was  de- 
rived from  this  weed,  in  any  of  the  ways  in  which 
it  is  commonly  used,  in  the  late  epidemics  of  our 
city.  Mr.  Howard  says  it  has  no  effect  in  preserv- 
ing from  the  plague. 

5.  Camphor  suspended  in  a  bag  round  the  neck, 
and  rags  wetted  in  vinegar,  and  applied  to  the  nose. 
These  means  were  in  general  use  in  the  fever  of 
1793,  in  Philadelphia,  but  they  afforded  no  pro- 
tection from  it.  It  is  possible  .they  had  a  contrary 
effect,  by  entangling,  in  their  volatile  particles, 
more  of  the  miasmata  of  the  fever,  and  thus  in- 
creasing a  predisposition  to  it. 

A  fourth  class  of  the  preventives  of  malignant  fe- 
vers are  certain  substances  which  are  said  to  destroy 
miasmata  bv  entering  into  mixture  with  them. 
Two  persons,  who  were  very  much  exposed  to  the 
causes  of  the  fever  in  1798,  took  each  of  them  a 
table  spoonful  of  sweet  oil  every  morning.  They 
both  escaped  the  fever.  Did  the  oil,  in  these 
cases,  act  by  destroying  miasmata  in  the  stomach 
chemically  ?   or  did  it  defend  the  stomach  mecha- 


192         ON    THE    MEANS    OF    PREVENTING 

nically  from  their  action  ?-  or  did  it  prevent  the  dis- 
ease, only  by  gently  opening  the  bowels?  It  is 
certain  the  fat  of  pork  meat  protects  the  men  who 
work  in  the  lead-mines  of  Great-Britain  from  the 
deleterious  effects  which  the  fumes  of  that  metal 
are  apt  to  bring  upon  the  stomach  and  bowels,  and 
that  a  poisoned  arrow,  discharged  into  the  side  of 
a  hog,  will  not  injure  him,  if  it  be  arrested  by  the 
fat  which  lines  that  part  of  his  body. 

The  vapour  which  issues  from  fresh  earth  has 
been  supposed  to  destroy  the  miasmata  which  pro- 
duce malignant  fevers,  by  entering  into  mixture 
with  them.  Most  of  the  men  who  were  employed 
in  digging  graves  and  cellars,  and  in  removing  the 
dirt  from  the  streets  of  Philadelphia,  in  1793, 
escaped  the  fever  of  that  year.  In  the  new  settle- 
ments of  our  country,  it  is  said,  the  poison  of  the 
rattlesnake  is  deprived  of  its  deadly  effects  upon 
the  body,  by  thrusting  the  wounded  limb  into  a 
hole,  recently  made  in  the  earth.  The  fable  of  An- 
teus,  who  rose  with  renewed  strength  from  the 
ground  after  repeated  falls,  was  probably  intended 
to  signify,  among  other  things,  the  salutary  virtues 
which  are  contained  in  the  effluvia  which  issue  from 
fresh  clods  of  earth. 


,    SUMMER    AND    AUTUMNAL    DISEASE.      193 

3.  There  are  many  facts  which  show  the  effi- 
cacy of  the  volatile  alkali  in  destroying,  by  mix- 
ture, the  poison  of  snakes.  One  of  them  was 
lately  communicated  to  the  public  by  Dr.  Kamsay, 
of  South-  Carolina.  What  would  be  the  effect  of  the 
daily  use  of  a  few  tea-  spoonfuls  of  this  medicine  in 
a  liquid  form,  and  of  frequently  washing  the  body 
with  it,  during  the  prevalence  of  pestilential  epi- 
demics? 

The  miasmata  which  produce  malignant  fevers 
often  exist  in  an  inoffensive  state  in  the  body,  for 
wreeks,  and  perhaps  months,  without  doing  any 
harm.  With  but  a  few  exceptions,  they  seldom 
induce  a  disease  without  the  reinforcement  of  an 
exciting  cause.  In  vain,  therefore,  shall  we  use 
all  the  preventives  that  have  been  recommended, 
without, 

V.  Avoiding  of  all  its  exciting  causes.  These 
are, 

1.  Heat  and  cold.  While  {he  former  has  excit- 
ed the  yellow  fever  in  thousands,  the  latter  has  ex- 
cited it  in  tens  of  thousands.  It  is  not  in  middle 
latitudes  only  that  cold  awakens  this  disease  in  the 
body.  Dr.  Mosely  says  it  is  a  more  frequent  ex- 
citing cause  of  that,  and  of  other  diseases,  in  the 

VOL.  IV.  2  B 


194        ON    THE    MEANS    OF    PREVENTING 

island  of  Jamaica,  than  in  any  of  the  most  tempe- 
rate climates  of  the  globe.  It  is  this  which  renders 
cases  of  yellow  fever,  when  epidemic  in  our  cities, 
more  numerous  in  the  cool  months  of  September 
and  October,  than  in  July  and  August.  For  the 
purpose  of  avoiding  this  pernicious  and  universal 
influence  of  cold,  the  clothing  and  bed-covers  should 
be  rather  warmer  in  those  months,  in  middle  and 
northern  latitudes,  than  is  agreeable,  and  fires  should 
be  made  every  morning  and  evening  in  common 
sitting  rooms,  and  during  the  whole  day,  when  the 
weather  is  damp  or  cool.  They  serve,  not  only 
to  prevent  the  reduction  of  the  excitement  of  the 
blood-vessels,  by  the  gradual  and  imperceptible  ab- 
straction of  the  heat  of  the  body,  but  to  convey  up 
a  chimney  all  the  unwholesome  air  that  accumulates 
in  those  rooms  during  a  sickly  season.  By  these 
precautions,  I  have  known  whole  families  preserv- 
ed in  health,  while  all  their  neighbours  who  neg- 
lected them,  have  been  confined  by  a  prevailing 
autumnal  fever. 

3.  The  early  morning  and  evening  air,  even  in 
warm  weather. 

4.  Fatigue  from  amusements,  such  as  fishing, 
gunning,  and  dancing,  and  from  unusual  labour  or 
exercise.     The  effects  of  fatigue  from  this  cause 


SUMMER     AND    AUTUMNAL     DISEASE.      195 

have  been  already  noticed*,  in  the  maids  of  large 
families  being  the  only  persons  who  die  of  the  fe- 
ver, in  consequence  of  their  having  performed 
great  and  unusual  services  to  those  branches  of  the 
family  who  survive  them,  while  nurses,  who  only 
exercise  their  ordinary  habits  in  attending  sick  peo- 
ple, are  seldom  carried  off  by  it. 

5.  Intemperance  in  eating  and  drinking. 

6.  Partaking  of  new  aliments  and  drinks.  The 
stomach,  during  the  prevalence  of  malignant  fevers, 
is  always  in  an  irritable  state,  and  constantly  dis- 
posed to  be  affected  by  impressions  that  are  not  ha- 
bitual to  it. 

7.  Violent  emotions  or  passions  of  the  mind. 

8.  The  entire  cessation  of  moderate  labour. 
This,  by  permitting  the  mind  to  ramble  upon  subjects 
of  terror  and  distress,  and  by  exposing  the  body  to 
idleness  and  company,  favours  an  attack  of  fever. 
A  predisposition  to  it,  is  likewise  created  by  alter- 
nating labour  and  idleness  with  each  other. 

9.  The  continuance  of  hard  labour.  The 
miasmata  which  produce  malignant  fevers  some- 

*  Account  of  the  Yellow  Fever  in  1793,  vol.  iii. 


196       ON     THE    MEANS    OF    PREVENTING 

times  possess  so  much  force,  that  the  least  addition 
to  it,  even  from  customary  acts  of  labour,  is  suffi- 
cient to  excite  the  disease.  In  this  case,  safety 
should  be  sought  in  retirement,  more  especially  by 
those  persons  whose  occupations  expose  them  to 
the  heat  of  fires,  and  the  rays  of  the  sun,  such  as 
hatters,  smiths,  bricklayers,  and  house  and  ship 
carpenters.  The  wealthy  inhabitants  of  Constan- 
tinople and  Smyrna  erroneously  suppose  they 
escape  the  contagion  of  the  plague,  by  shutting 
themselves  up  in  their  houses  during  its  preva- 
lence. They  owe  their  preservation  chiefly  to  their 
being  removed,  by  an  exemption  from  care 
and  business,  from  all  its  exciting  causes.  Most 
of  the  nobility  and  gentry  of  Moscow,  by  these 
means  escaped  a  plague  which  carried  off  27,000 
persons  in  that  city,  in  the  year  1771,  and  many 
whole  families  in  Philadelphia  were  indebted 
for  their  safety  to  the  same  precautions  in  the  year 
1793.  Confinement  is  more  certain  in  its  benefi- 
cial effects,  when  persons  occupy  the  upper  stories 
only  of  their  houses.  The  inhabitants  of  St.  Lu- 
cia, Dr.  Chisholm  says,  by  this  means  often  escape 
the  yellow  fever  of  that  island.  Such  is  the  differ- 
ence between  the  healthiness  of  the  upper  and  low- 
er stories  of  a  house,  that,  travellers  tell  us,  birds 
live  in  the  former,  and  die  in  the  latter,  during  the 
prevalence  of  a  plague  in  the  eastern  countries. 


SUMMER     AND    AUTUMNAL    DISEASE.      197 

All  the  exciting  causes  that  have  been  enume- 
rated should  be  avoided  with  double  care  three  days 
before,  and  three  days  after,  as  well  as  on  the  days 
of  the  full  and  change  of  the  moon.  The  reason 
for  this  caution  was  given  in  the  account  of  the  yel- 
low fever  in  Philadelphia  in  the  year  1797. 

To  persons  who  have  retired  from  infected  ci- 
ties, or  countries,  it  will  be  necessary  to  suggest  a 
caution,  not  to  visit  them  while  the  malignant  fever 
from  which  they  fled  prevails  in  them.  Dr.  Dow 
informed  me,  in  his  visit  to  Philadelphia  in  the  year 
1800,  that  the  natives  and  old  citizens  of  New- Or- 
leans who  retired  into  the  country,  and  returned 
during  the  prevalence  of  the  yellow  fever  in  that 
city,  the  year  before,  were  often  affected  by  it,  while 
all  such  persons  as  did  not  change  their  residence, 
escaped  it.  The  danger  from  visiting  an  infected 
city  is  greater  to  persons  who  breathe  an  atmo- 
sphere of  a  uniform  temperature,  than  one  that  is 
subject  to  alternate  changes  in  its  degrees  of  heat 
and  cold.  The  inhabitants  of  Mexico,  Baron 
Humboldt  informed  me,  who  descend  from  their 
elevated  situation,  where  the  thermometer  seldom 
varies  more  than  ten  degrees  in  the  year,  and  visit 
Vera  Cruz  during  the  prevalence  of  the  yellow  fe- 
ver in  that  city,  are  much  oftener  affected  by  it 
than  the  new  comers  from  the  variable  climates  of 


1§8        ON    THE     MEANS    OF    PREVENTING 

European  countries.  But  the  habits  of  insensibi- 
lity to  the  impressions  of  the  miasmata  of  this  dis- 
ease in  one  country,  do  not  always  protect  the  sys- 
tem from  their  action  in  another.  The  same  illus- 
trious traveller  informed  me,  that  the  inhabitants  of 
the  Havannah  who  visit  Vera  Cruz,  and  the  inha- 
bitants of  Vera  Cruz  who  visit  the  Havannah,  are 
affected  in  common  with  strangers  with  the  fever 
of  those  places. 

I  shall  take  leave  of  this  part  of  our  subject,  by 
adding,  that  I  am  so  much  impressed  with  a  belief 
in  the  general,  and  almost  necessary  connection  of 
an  exciting  cause  with  a  yellow  fever,  that  were  I 
to  enter  a  city,  and  meet  its  inhabitants  under  the 
first  impressions  of  terror  and  distress  from  its  ap- 
pearance, my  advice  to  them  should  be,  "Beware, 
not  of  contagion,  for  the  yellow  fever  of  our  coun- 
try is  not  contagious,  nor  of  putrid  exhalations, 
when  the  duties  of  humanity  or  consanguinity  re- 
quire your  attendance,  but  beware  of  exciting 

CAUSES !" 

In  the  mild  grades  of  the  summer  and  autumnal 
fevers  of  the  United  States,  the  means  of  preven- 
tion should  be  different  from  those  which  have 
been  recommended  to  prevent  the  yellow  fever. 
They  consist  of  such  things  as  gently  invigorate 


SUMMER    AND    AUTUMNAL    DISEASE.      199 

the  system,  and  thus  create  an  action  superior  to 
that  which  the  miasmata  have  excited  in  it.  The 
means  commonly  employed  for  this  purpose  are, 

1.  Cordial  diet  and  drinks  ;  consisting  of  salted 
meat,  and  fish,  with  a  moderate  quantity  of  wine 
and  malt  liquors.  Dr.  Blane  says,  the  British  sol- 
diers who  lived  upon  salt  meat,  during  the  Ameri- 
can war,  were  much  less  afflicted  with  the  intermit- 
ting fever  than  the  neighbouring  country  people  ; 
and,  it  is  well  known,  the  American  army  was  much 
less  afflicted  with  summer  and  autumnal  fevers, 
after  they  exchanged  their  fresh  meat  for  rations  of 
salted  beef  and  pork.  Ardent  spirits  should  be 
used  cautiously,  for,  when  taken  long  enough  to 
do  good,  they  create  a  dangerous  attachment  to 
them.  A  strong  infusion  of  any  bitter  herb  in  wa- 
ter, taken  upon  an  empty  stomach,  is  a  cheap  sub- 
stitute for  all  the  above  liquors  where  they  cannot 
be  afforded.  The  Peruvian  bark  has  in  many  in- 
stances been  used  with  success  as  a  preventive  of 
the  mild  grades  of  the  summer  and  autumnal  fevers 
of  our  country. 

2.  An  equable  and  constant  perspiration.  This 
should  be  kept  up  by  all  the  means  formerly  men- 
tioned for  that  purpose. 


200        ON    THE    MEANS    OF    PREVENTING 

3.  Avoiding  certain  exciting  causes,  particularly 
great  heat  and  cold,  fatigue,  long  intervals  between 
meals,  intemperance,  and  the  morning  and  evening 
air,  more  especially  during  the  lunar  periods  for- 
merly mentioned.  Dr.  Lind  says,  the  farmers  of 
Holdernesse,  in  England,  who  go  out  early  to  their 
work,  are  seldom  long  lived,  probably  from  their 
constitutions  being  destroyed  by  frequent  attacks 
of  intermitting  fevers,  to  which  that  practice  exposes 
them.  Where  peculiar  circumstances  of  business 
render  it  necessary  for  persons  to  inhale  the  morn- 
ing air,  care  should  be  taken  never  to  do  it  with- 
out first  eating  a  cordial  breakfast. 

The  intestinal  state  of  our  summer  and  autumnal 
disease  requires  several  specific  means  to  prevent 
it,  different  from  those  which  have  been  advised  to 
defend  the  blood-vessels  from  fever.  Unripe  and 
decayed  fruit  should  be  avoided,  and  that  which  is 
ripe  and  sound  should  not  be  eaten  in  an  excessive 
quantity.  Spices,  and  particularly  Cayenne  pep- 
per, and  the  red  pepper  of  our  country,  should  be 
taken  daily  with  food.  Mr.  Dewar,  a  British  sur- 
geon, tells  us,  the  French  soldiers,  while  in  Egypt, 
carried  pepper  in  boxes  with  them,  wherever  they 
went,  to  eat  with  the  fruits  of  the  country,  and 
thereby  often  escaped  its  diseases.  The  whole 
diet,  during  the  prevalence  of  intestinal  diseases, 


SUMMER    AND    AUTUMNAL    DISEASE.     201 

when  they  are  not  highly  inflammatory,  should  be 
of  a  cordial  nature.  A  dysentery  prevailed,  a  few 
years  ago,  upon  the  Potomac,  in  a  part  of  the  coun- 
try which  was  inhabited  by  a  number  of  protestant 
and  catholic  families.  The  disease  was  observed 
to  exist  only  in  the  former.  The  latter,  who  ate 
of  salted  fish  every  Friday,  and  occasionally  ©n 
other  days  of  the  week,  very  generally  escaped  it. 
In  the  year  1759,  a  dysentery  broke  out  in  the  vil- 
lage of  Princeton,  in  New-Jersey,  and  affected  ma- 
ny of  the  students  of  the  college.  It  was  remark- 
ed, that  it  passed  by  all  those  boys  who  came  from 
the  cities  of  New- York  and  Philadelphia.  This 
was  ascribed  to  their  having  lived  more  upon  tea 
and  coffee  than  the  farmers's  sons  in  the  college ; 
for  those  cordial  articles  of  diet  were  but  rarely 
used,  six  and  forty  years  ago,  in  the  farm  houses 
of  the  middle  states  of  America.  I  mentioned  for- 
merly that  the  cordial  diet  of  the  inhabitants  of  our 
cities  was  probably  the  reason  why  the  dysentery 
so  seldom  prevailed  as  an  epidemic  in  them. 

Another  means  of  preventing  the  dysentery  is, 
by  avoiding  costiveness,  and  by  occasionally  tak- 
ing purging  physic,  even  when  the  bowels  are  in 
their  natural  state.  A  militia  captain,  in  the  Penn- 
sylvania service,  preserved  his  whole  company  from 
a  dysentery  which  prevailed  in  a  part  of  the  Ame- 

vol.   iv.  2  c 


202        ON    THE    MEANS    OF    PREVENTING 

rican  army  at  Amboy,  in  the  year  1776,  by  giving 
each  of  them  a  purge  of  sea- water.  He  preserved 
his  family,  and  many  of  his  neighbours,  some  years 
afterwards,  from  the  same  disease,  by  dividing 
among  them  a  few  pounds  of  purging  salts.  It 
was  prevented,  a  few  years  ago,  in  the  academy  of 
Bordentown,  in  New- Jersey,  by  giving  all  the 
boys  molasses,  in  large  quantities,  in  their  diet  and 
drinks.  The  molasses  probably  acted  only  by 
keeping  the  bowels  in  a  laxative  state. 

As  the  dysentery  is  often  excited  by  the  damp- 
ness of  the  night  air,  great  care  should  be  taken  to 
avoid  it,  and,  when  necessarily  exposed  to  it,  to 
defend  the  bowels  by  more  warmth  than  other  parts 
of  the  body.  The  Egyptians,  Mr.  Dewar  says, 
tie  a  belt  about  their  bowels  for  that  purpose,  and 
with  the  happiest  effects. 

II.  I  come  now,  according  to  theorder  I  proposed, 
to  mention  the  means  of  preserving  whole  cities  or 
communities  from  the  influence  of  those  morbid 
exhalations  which  produce  the  different  forms  of 
summer  and  autumnal  disease,  and,  in  particular, 
that  which  is  of  a  malignant  nature. 


SUMMER    AND    AUTUMNAL    DISEASE.     203 

As  the  flight  of  a  whole  city  is  rarely  practicable, 
it  will  be  necessary  to  point  out  the  means  of  de- 
stroying the  morbid  miasmata. 

1.  Where  the  putrid  matters  which  emit  them 
are  of  a  small  extent,  they  should  be  covered  with 
water  or  earth.  Purchas  tells  us,  500  persons  less 
died  of  the  plague  the  day  after  the  Nile  overflowed 
the  grounds  which  had  emitted  the  putrid  exhala- 
tions that  produced  it,  than  had  died  the  day  before. 
During  the  prevalence  of  a  malignant  fever,  it  will 
be  unsafe  to  remove  putrid  matters.  A  plague  was 
generated  by  an  attempt  to  remove  the  filth  which 
had  accumulated  on  the  banks  of  the  waters  which 
surround  the  city  of  Mantua,  during  the  sum- 
mer and  autumnal  months*.  Even  a  shower  of 
rain,  by  disturbing  the  green  pellicle  which  is  some- 
times formed  over  putrid  matters,  I  shall  mention 
in  another  place,  has  let  loose  exhalations  that  have 
produced  a  pestilential  disease. 

2.  Impregnating  the  air  with  certain  eifluvia, 
which  act  either  by  destroying  miasmata  by  means 
of  mixture,  or  by  exciting  a  new  action  in  the  sys- 
tem, has,  in  some  instances,  checked  the  progress 
of  a  malignant  fever.     The  air  extricated  from  fer- 

*  Burserus. 


204        ON    THE    MEANS    OF    PREVENTING 

meriting  wines,  during  a  plentiful  vintage,  Van- 
sweitcn  tells  us,  has  once  checked  the  ravages  of  a 
plague  in  Germany.  Ambrose  Parey  informs  u$, 
the  plague  was  checked  in  a  city  in  Italy  by  killing 
all  the  cats  and  dogs  in  the  place,  and  leaving  them 
to  putrify  in  the  streets.  Mr.  Bruce  relates,  that 
all  those  persons  who  lived  in  smoky  houses,  in 
one  of  the  countries  which  he  visited,  escaped  bili- 
ous fevers,  and  Dr.  Clark  mentions  an  instance,  in 
which  several  cooks,  who  were  constantly  exposed 
to  smoke,  escaped  a  fever  which  affected  the  whole 
crew  of  a  galley.  The  yellow  fever  has  never  ap- 
peared within  the  limits  of  the  effluvia  of  the  sal 
ammoniac  manufactory,  nor  of  the  tan-pits  in  the 
suburbs  of  Philadelphia,  nor  has  the  city  of  Lon- 
don been  visited  with  a  plague  since  its  inhabitants 
have  used  sea-coal  for  fuel.  But  other  causes 
have  contributed  more  certainly  to  the  exemption 
of  that  city  from  the  plague  for  upwards  of  a  cen- 
tury, one  of  which  shall  be  mentioned  under  our 
next  head. 

3.  Desquenette  tells  us,  the  infection  of  the 
plague  never  crosses  the  Nile,  and  that  it  is  arrest- 
ed by  means  of  ditches,  dug  and  filled  with  water 
for  that  purpose.  Dr.  Whitman  has  remarked, 
that  the  plague  never  passes  from  Abydos,  on  the 
Turkish,  to  Mito,  on  the  European  side  of  the  wa- 


SUMMER    AND    AUTUMNAL    DISEASE.     205 

ter  of  the  Dardanelles,  which  forms  the  entrance  to 
Constantinople.  The  yellow  fever  has  never  been 
known  to  pass  from  Philadelphia  to  the  Jersey  shore, 
and  the  miasmata  generated  on  the  east  side  of  the 
Schuylkill  rarely  infect  the  inhabitants  of  the  opposite 
side  of  the  river.  Many  persons  found  safety  from 
the  plague  of  London,  in  1665,  by  flying  to  ships 
which  lay  in  the  middle  of  the  Thames,  and,  it  is 
well  known,  no  instance  of  yellow  fever  occurred 
in  those  Philadelphia  families  that  confined  them- 
selves to  ships  in  the  middle  of  the  Delaware,  in 
the  year  1793.  But  three  or  four,  of  four  hun- 
dred men,  on  board  a  ship  of  war  called  the  Jason, 
commanded  by  captain  Coteneuil,  perished  with  an 
epidemic  yellow  fever,  in  the  year  1746,  at  St.  Do- 
mingo, in  consequence,  Dr.  Desportes  says,  of  her 
hold  being  constantly  half  filled  with  water*.  I 
have  multiplied  facts  upon  this  subject,  because 
they  lead  to  important  conclusions.  They  show 
the  immense  consequence  of  frequently  washing 
the  streets  and  houses  of  cities,  both  to  prevent 
and  check  pestilential  fevers.  What  would  be  the 
effect  of  placing  tubs  of  fresh  water  in  the  rooms 
of  patients  infected  with  malignant  fevers,  and  in 
an  atmosphere  charged  with  putrid  exhalations? 

*  Vol.  I.  p,  161. 


206        ON    THE    MEANS    OF    PREVENTING 

Their  efficacy  in  absorbing  the  matter  which  con- 
stitutes the  odour  of  fresh  paint,  favours  a  hope  that 
they  would  be  useful  for  that  purpose.  I  have 
mentioned  an  instance,  in  the  Account  of  the  Yel- 
low Fever  in  Philadelphia,  in  the  year  1797,  in 
which  they  were  supposed  to  have  been  employed 
with  evident  advantage. 

4.  Intercepting  the  passage  of  miasmata  to  the 
inhabitants  of  cities.  Varro,  in  his  Treatise  upoa 
Agriculture,  relates,  that  his  namesake  Varro,  a 
Roman  general,  was  in  great  danger  of  suffering, 
with  a  large  fleet  and  army,  from  a  malignant  fever 
at  Conyra.  Having  discovered  the  course  of  the 
miasmata  which  produced  it  to  be  from  the  south, 
he  fastened  up  all  the  southern  windows  and  doors 
of  the  houses  in  which  his  troops  were  quartered, 
and  opened  new  ones  to  the  north,  by  which  means 
he  preserved  them  from  the  fever  which  prevailed 
in  all  the  other  houses  of  the  town  and  neighbour- 
hood. Mr.  Howaru  advises  keeping  the  doors 
and  windows,  of  houses  which  are  exposed  to  the 
plague,  constantly  shut,  except  during  the  time  of 
sunshine. 

Several  other  means  have  been  recommended  to 
preserve  cities  from  malignant  fevers  during  their 


SUMMER    AND    AUTUMNAL    DISEASE.     207 

prevalence,  which  are  of  doubtful  efficacy,  or  evi- 
dently hurtful.     They  are, 

5.  Strewing  lime  over  putrid  matters.  Dr. 
Dalzelle  says,  he  once  checked  a  bilious  fever,  by 
spreading  twelve  barrels  of  lime  on  a  piece  of 
marshy  ground,  from  whence  the  exhalations  that 
produced  it  were  derived*.  A  mixture  of  quick 
lime  and  ashes  in  water,  when  thrown  into  a 
privy,  discharges  from  it  a  large  quantity  of  offen- 
sive air,  and  leaves  it  afterwards  without  a  smell. 
As  this  foul  air  is  discharged  into  the  atmosphere, 
it  has  been  doubted  whether  the  lime  and  ashes 
should  be  used  for  that  purpose,  after  a  malignant 
fever  has  made  its  appearance. 

6.  Mr.  Quiton  Morveau  has  lately  proposed  the. 
muriatic  gas  as  a  means  of  destroying  miasmata. 
However  effectual  it  may  be  in  destroying  the  vo- 
latile and  foul  excretions  which  are  discharged  from 
the  human  body  in  confined  situations,  as  in  filthy 
jails,  hospitals,  and  ships,  it  is  not  calculated  to 
oppose  the  seeds  of  a  disease  which  exist  in  the  at- 
mosphere, and  which  are  diffused  over  a  large  ex- 
tent of  city  or  country.  Mr.  Morveau  ascribes 
great  virtues  to  it,  in  checking  the  malignant  fever 

*  Sur  les  Maladies  des  Climats  Chauds. 


208  ON    THE    MEANS    OF    PREVENTING 

in  Cadiz,  in  1801,  but  from  the  time  at  which  it 
was  used,  being  late  in  the  autumn,  there  is  more 
reason  to  believe  it  had  run  its  ordinary  course,  or 
that  it  was  destroyed  by  cold  weather. 

7.  The  explosion  of  gunpowder  has  been  re- 
commended for  checking  pestilential  diseases.  Mr. 
Quiton  Morveau  says,  it  destroys  the  offensive 
odour  of  putrid  exhalations,  but  does  not  act  upon 
the  fevers  produced  by  them. 

8.  Washing  the  floors  of  houses  with  a  solution 
of  alkaline  salts  in  water,  has  been  recommended 
by  Dr.  Mitchell,  as  an  antidote  to  malignant  fevers. 
As  yet,  I  believe,  there  are  no  facts  which  establish 
the  efficacy  of  the  practice,  when  they  are  produced 
by  exhalations  from  decayed  vegetable  and  animal 
substances  in  a  putrid  state. 

9.  Large  fires  have  sometimes  been  made  in  ci- 
ties, in  order  to  destroy  the  miasmata  of  pestilential 
diseases.  They  were  obviously  hurtful  in  the 
plague  of  London,  in  the  year  1665.  Dr.  Hodges, 
who  relates  this  fact,  says,  "  Heaven  wept  for  the 
mistake  of  kindling  them,  and  mercifully  put  them 
out,  with  showers  of  rain." 


SUMMER    AND    AUTUMNAL    DISEASE.     209 

I  cannot  conclude  this  head,  without  lamenting 
the  want  of  laws  in  all  our  states,  to  compel  physi- 
cians to  make  public  the  first  cases  of  malignant 
fever  that  come  under  their  notice.  The  cry  of 
fire  is  not  more  useful  to  save  a  city  from  destruc- 
tion, than  the  early  knowledge  of  such  cases  would 
be  to  save  it  from  the  ravages  of  pestilential  and 
mortal  epidemics.  Hundreds  of  instances  have  oc- 
curred, in  all  ages  and  countries,  in  which  they 
might  have  been  stifled  in  their  birth,  by  the  means 
that  have  been  mentioned,  had  this  practice  been 
adopted.  But  when,  and  where,  will  science,  hu- 
manity, and  government  first  combine  to  accom- 
plish this  salutary  purpose  ?  Most  of  our  histories 
of  mortal  epidemics  abound  with  facts  which  show 
a  contrary  disposition  and  conduct  in  physicians, 
rulers,  and  the  people.  I  shall  mention  one  of 
these  facts  only,  to  show  how  far  we  must  tra- 
vel over  mountains  of  prejudice  and  error,  be- 
fore we  shall  witness  that  desirable  event.  It  is 
extracted  from  the  second  volume  of  the  Life  of 
the  late  Empress  of  Russia.  "  The  Russian  army 
(says  the  biographer),  after  defeating  the  Turks,  on 
entering  their  territories  were  met  by  the  plague, 
and  brought  it  to  their  country,  where  the  folly  of 
several  of  their  generals  contributed  to  its  propaga- 
tioiij  as  if  they  thought  by  a  military  wTord  of  com- 
mand to  alter  the  nature  of  things.     Lieutenant- 

vol.   iv.  2d 


210        ON    THE    MEANS    OF    PREVENTING 

general  Stoffeln,  at  Yassy,  where  the  pestilence 
raged  in  the  winter  of  1770,  issued  peremptory  or- 
ders that  its  name  should  not  be  pronounced ;  he 
even  obliged  the  physicians  and  surgeons  to  draw 
up  a  declaration  in  writing,  that  it  was  only  a  spot- 
ted fever.  One  honest  surgeon  of  the  name  of 
Kiuge  refused  to  sign  it.  In  this  manner  the  sea- 
son of  prevention  was  neglected.  Several  thou- 
sand Russian  soldiers  were  by  this  means  carried 
off.  The  men  fell  dead  upon  the  road  in  heaps. 
The  number  of  burghers  that  died  was  never 
known,  as  they  had  run  into  the  country,  and  into 
the  forests.  At  length  the  havoc  of  death  reached 
the  general's  own  people  :  he  remained  true  to  his 
persuasion,  left  the  town,  and  went  into  the  more 
perilous  camp.  But  his  intrepidity  availed  him 
nothing  ;  he  died  of  the  plague  in  July,  1771*." 

III.  Let  us  now  consider,  in  the  last  place,  the 
means  of  exterminating  malignant  and  other  forms 
of  summer  and  autumnal  disease,  by  removing  their 
causes.     These  means  are, 

1 .  The  removal  or  destruction  of  all  those  pu- 
trid matters  formerly  enumerated,  which  are  capa- 

*  The  above  disease  appears  to  have  been  the  camp  fever, 
the  origin  and  character  of  which  will  be  noticed  in  the  next 
article. 


SUMMER    AND     AUTUMNAL     DISEASE.     211 

ble  of  producing  fevers.  Many  of  the  institutions 
of  the  Jewish  nation,  for  this  purpose,  are  worthy 
of  our  imitation.  The  following  verses  contain  a 
fund  of  useful  knowledge  upon  this  subject. — 
"  Thou  shalt  have  a  place  without  the  carnp,  whe- 
ther thou  shalt  go  forth  abroad ;  and  shalt  have  a 
paddle  upon  thy  weapon,  and  it  shall  be  when  thou 
wilt  ease  thyself  abroad,  thou  shalt  dig  therewith, 
and  shalt  turn  back,  and  cover  that  which  cometh 
from  thee ;  for  the  Lord  thy  God  walketh  in  the 
midst  of  thy  camp  to  deliver  thee,  therefore  shall 
he  see  no  unclean  thing  in  thee,  and  turn  away 
from  thee."  Deuteronomy,  chapter  xxiii.  verses 
12,  13,  and  14.  "  But  the  flesh  of  the  bullock, 
and  his  skin,  and  his  dung,  shalt  thou  burn  with 
fire  'without  the  campy  Exodus,  chapter  xxxix. 
verse  14.  The  advantages  of  thus  burying 
and  removing  all  putrid  matters,  and  of  burning 
such  as  were  disposed  to  a  speedy  putrefaction,  in 
a  crowded  camp,  and  in  a  warm  climate,  are  very 
obvious.  Their  benefits  have  often  been  realized 
in  other  countries.  The  United  Provinces  of  Hol- 
land hold  their  exemption  from  the  plague,  only  by 
the  tenure  of  their  cleanliness.  In  the  character 
given  by  Luther  of  Pope  Julius,  he  says,  "  he 
kept  the  streets  of  Rome  so  clean  and  sweet,  that 
there  were  no  plagues  nor  sicknesses  during  his 
time."     The  city  of  Oxford  was  prepared  to  aiford 


212        ON    THE    MEANS    OF    PREVENTING 

an  asylum  to  the  roval  family  of  Great-Britain 
from  the  plague,  when  it  ravaged  London,  and 
other  parts  of  England,  in  the  year  1665,  only 
in  consequence  of  its  having  been  cleaned,  some 
years  before,  by  the  Bishop  of  Winchester.  In  a 
manuscript  account  of  the  life  of  Doctor,  afterwards 
Governor  Col  den,  of  New- York,  there  is  the  fol- 
lowing fact.  It  was  first  communicated  to  the 
public  in  the  daily  gazette  of  the  capital  of  that 
state,  on  the  30th  of  October,  1799.  "  A  malig- 
nant fever  having  raged  with  exceeding  violence 
for  two  summers  successively  in  the  city  of  Newr 
York,  about  forty  years  ago,  he  communicated  his 
thoughts  to  the  public,  on  the  most  probable  cure 
of  the  calamity.  He  published  a  little  treatise  on 
the  occasion,  in  winch  he  collected  the  sentiments 
of  the  best  authority,  on  the  bad  effects  of  stagnat- 
ing waters,  moist  air,  damp  cellars,  filthy  shores, 
and  dirty  streets.  He  showed  how  much  these 
nuisances  prevailed  in  many  parts  of  the  city,  and 
pointed  out  the  remedies.  The  corporation  of  the 
city  voted  him  their  thanks,  adopted  his  reasoning, 
and  established  a  plan  for  draining  and  cleaning  the 
city,  which  was  attended  with  the  most  happy  ef- 
fects." The  advantages  of  burning  offal  matters, 
capable  by  putrefaction  of  producing  fevers,  has 
been  demonstrated  by  those  housekeepers,  who, 
instead  of  collecting  the  entrails  of  fish  and  poultry, 


SUMMER    AND    AUTUMNAL    DISEASE.     215 

and  the  parings  and  skins  of  vegetables,  in  barrels, 
instantly  throw  them  into  their  kitchen  fires.  The 
families  of  such  persons  are  generally  healthy. 

2.  In  the  construction  of  cities,  narrow  streets 
and  alleys  should  be  carefully  avoided.  Deep  lots 
should  be  reserved  for  yards  and  gardens  for  all  the 
houses,  and  subterraneous  passages  should  be  dug 
to  convey,  when  practicable,  to  running  water,  the 
contents  of  privies,  and  the  foul  water  of  kitchens. 
In*  cities  that  are  wholly  supplied  with  fresh  water 
by  pipes  from  neighbouring  springs  or  rivers,  all 
the  evils  from  privies  might  be  prevented  by  dig- 
ging them  so  deep  as  to  connect  them  with  water. 
Great  advantages,  it  has  been  suggested,  would 
arise  in  the  construction  of  cities,  from  leaving  open 
squares,  equal  in  number  and  size  to  those  which 
are  covered  with  houses.  The  light  and  dark 
squares  of  a  chequer-board  might  serve  as  models 
for  the  execution  of  such  a  plan.  The  city  of 
London,  which  had  been  afflicted  nearly  every  year 
for  above  half  a  century  by  the  plague,  has  never 
been  visited  by  it  since  the  year  1666.  In  that 
memorable  year,  while  the  inhabitants  were  venting 
their  execrations  upon  a  harmless  bale  of  silks  im- 
ported from  Holland,  as  the  vehicle  of  the  seeds  of 
their  late  mortal  epidemic,  Heaven  kindly  pointed 
out,  and  removed  its  cause,  by  permitting  a  fire  to 


214        ON    THE    MEANS    OF    PREVENTING 

destroy  whole  streets  and  lanes  of  small  wooden 
buildings,  which  had  been  die  reservoirs  of  filth 
for  centuries,  and  thereby  the  sources  of  all  the 
plagues  of  that  city*.  Those  streets  and  lanes 
were  to  London,  what  Water-street  and  Farmer's- 
row  are  to  Philadelphia,  Fell's-point  to  Baltimore, 
the  slips  and  docks  to  New- York,  and  Water- 
street  to  the  town  of  Norfolk. 

3.  Where  the  different  forms  of  summer  and  au- 
tumnal disease  arise  from  marsh  exhalations,  they 
should  be  destroyed  by  drains,  by  wells  communi- 
cating with  their  subterraneous  springs,  or  by  cul- 
tivating upon  them  certain  grasses,  which  form  a 
kind  of  mat  over  the  soil,  and,  when  none  of  these 
modes  of  destroying  them  is  practicable,  by  over- 
flowing them  with  water. 

I  have  met  with  many  excellent  quotations  from 
a  work, upon  this  part  of  our  subject,  by  Tozzetti, 
an  Italian  physician,  from  which,  I  have  no  doubt, 
much  useful  information  might  be  obtained.  The 
Rev.  Thomas  Hall,  to  whom  I  made  an  unsuccess- 

*  A  proposal  was  made  to  replace  the  houses  that  had 
been  burnt,  by  similar  buildings,  and  upon  the  same  space 
of  ground.  Sir  Christopher  Wren  opposed  it,  and  with  the 
following  argument :  "  By  so  doing,  you  will  show  you 
have  not  deserved  the  late  fire  !" 


SUMMER    AND    AUTUMNAL    DISEASE.    215 

ful  application  for  this  work,  speaks  of  it,  in  his 
answer  to  my  letter,  in  the  following  terms. 
"  It  is  in  such  high  estimation,  that  the  late  empe- 
ror Leopold,  when  grand  duke  of  Tuscany,  caused 
it  to  be  re-printed  at  his  own  expence,  and  present- 
ed it  to  his  friends.  The  consequence  of  this  was, 
it  influenced  the  owners  of  low  marshy  grounds,  in 
the  neighbourhood  of  the  river  Arno,  to  drain  and 
cultivate  them,  and  thereby  rendered  the  abode  of 
noxious  air,  and  malignant  fevers,  a  terrestrial  pa- 
radise." 

4.  The  summer  and  autumnal  diseases  of  our 
country  have  often  followed  the  erection  of  mill- 
dams.  They  may  easily  be  obviated  by  surround- 
ing those  receptacles  of  water  with  trees,  which 
prevent  the  sun's  acting  upon  their  shores,  so  as  to 
exhale  miasmata  from  them.  Trees  planted  upon 
the  sides  of  creeks  and  rivers,  near  a  house,  serve 
the  same  salutary  purpose. 

5.  It  has  often  been  observed,  that  families  enjoy 
good  health,  for  many  years,  in  the  swamps  of  De- 
laware and  North- Carolina,  while  they  are  in  their 
natural  state,  but  that  sickness  always  follows  the 
action  of  the  rays  of  the  sun  upon  the  moist  surface 
of  the  earth,  after  they  are  cleared.  For  this  rea- 
son, the  cultivation  of  a  country  should  always  fol- 


216         ON    THE    MEANS    OF    PREVENTING 

low  the  cutting  down  of  its  timber,  in  order  to  pre- 
vent the  new  ground  becoming,  by  its  exhalations, 
a  source  of  disease. 

6.  In  commercial  cities,  no  vessel  that  arrives 
with  a  cargo  of  putrescent  articles  should  ever  be 
suffered  to  approach  a  wharf,  before  the  air  that  has 
been  confined  in  her  hold  has  been  discharged. 
The  same  thing  should  be  done  after  the  arrival  of 
a  vessel  from  a  distant  or  hot  country,  though  her 
cargo  be  not  capable  of  putrefaction,  for  air  acquires 
a  morbid  quality  by  stagnating  contiguous  to  wood, 
under  circumstances  formerly  mentioned. 

All  these  modes  of  removing  the  causes  of  ma- 
lignant and  yellow  fevers,  and  of  promoting  strict 
and  universal  cleanliness,  are  of  more  consequence 
in  the  middle  and  northern  states  of  America,  than 
in  countries  uniformly  warm,  inasmuch  as  the  dis- 
ease may  be  taken  as  often  as  our  inhabitants  are 
exposed  to  its  sources.  In  the  West- Indies,  a  se- 
cond attack  of  the  yellow  fever  is  prevented  by  the 
insensibility  induced  upon  the  system,  by  its  being 
constantly  exposed  to  the  impressions  of  heat  and 
exhalation.  After  a  seasoning,  as  it  is  called,  or 
a  residence  of  two  or  three  years  in  those  islands, 
the  miasmata  affect  the  old  settlers,  as  they  do  the 
natives,  onlv  with  mild  remittents.      Nearly  the 


SUMMER     AND    AUTUMNAL    DISEASE.     217 

same  thing  takes  place  at  Madras,  in  the  East- In- 
dies, where,  Dr.  Clark  says,  the  exhalations  which 
bring  on  bilious  fevers,  colic,  cholera,  and  spasmo- 
dic affections  in  new  comers,  produce  a  puking  in 
the  morning,  only  in  old  residents.  But  very  difw 
ferent  is  the  condition  of  the  inhabitants  of  the  mid- 
dle and  northern  states  of  America,  in  whom  the 
winters  prevent  the  acquisition  of  habits  of  insensi- 
bility to  the  heat  and  exhalations  of  the  previous 
summers,  and  thus  place  them  every  year  in  the 
condition  of  new  comers  in  the  West  and  East- 
Indies,  or  of  persons  who  have  spent  two  or  three 
years  in  a  cold  climate.  This  circumstance  in- 
creases the  danger  of  depopulation  from  our  malig- 
nant epidemics,  and  should  produce  corresponding 
exertions  to  prevent  them. 

In  enumerating  the  various  means  of  preventing 
and  exterminating  the  malignant  forms  of  fever,  it 
may  appear  strange  that  I  have  said  nothing  of  the 
efficacy  of  quarantines  for  that  purpose.  Did  I  be- 
lieve these  pages  would  be  read  only  by  the  citi- 
zens of  Pennsylvania,  I  would  do  homage  to  their 
prejudices,  by  passing  over  this  subject  by  a  res- 
pectful and  melancholy  silence  ;  but  as  it  is  proba- 
ble they  will  fall  into  the  hands  of  physicians  and 
citizens  of  other  states,  I  feel  myself  under  an  obli- 
gation to  declare,  that  I  believe  quarantines  are  of  no 

tol.   iv.  2e 


^  . 


218        ON    THE    MEANS    OF    PREVENTING 

efficacy  in  preventing  the  yellow  fever,  in  any  other 
way  than  by  excluding  the  unwholesome  air  that  is 
generated  in  the  holds  of  ships,  which  may  be  done 
as  easily  in  a  single  day,  as  in  weeks  or  months. 
They  originated  in  error,  and  have  been  kept  up 
by  a  supine  and  traditional  faith  in  the  opinions 
and  conduct  of  our  ancestors  in  medicine.  Mil- 
lions of  dollars  have  been  wasted  by  them.  From 
their  influence,  the  commerce,  agriculture,  and  ma- 
nufactures of  our  country  have  suffered  for  many 
years.  But  this  is  not  all.  Thousands  of  lives 
have  been  sacrificed,  by  that  faith  in  their  efficacy, 
which  has  led  to  the  neglect  of  domestic  cleanliness. 
Distressing  as  these  evils  are,  still  greater  have  ori- 
ginated from  them  ;  for  a  belief  in  the  contagious 
nature  of  the  yellow  fever,  which  is  so  solemnly  en- 
forced by  the  execution  of  quarantine  laws,  has  de- 
moralized our  citizens.  It  has,  in  many  instances, 
extinguished  friendship,  annihilated  religion,  and 
violated  the  sacraments  of  nature,  by  resisting  even 
the  loud  and  vehement  cries  of  filial  and  parental 
blood. 

While  I  thus  deny  the  yellow  fever  to  be  the 
offspring  of  a  specific  contagion,  and  of  course  in- 
capable of  being  imported  so  as  to  become  an  epi- 
demic in  any  country,  I  shall  admit  presently,  that 
the  excretions  of  a  patient  in  this  disease  may,  by 


SUMMER    AND    AUTUMNAL    DISEASE.     219 

eonfinement,  become  so  acrid  as  to  produce,  under 
circumstances  to  be  mentioned  hereafter,  a  similar 
disease  in  a  person,  but  from  this  person  it  cannot 
be  communicated,  if  he  possess  only  the  common 
advantages  of  pure  air  and  cleanliness.  To  enforce 
a  quarantine  law,  therefore,  under  such  a  contin- 
gent circumstance,  and  at  the  expence  of  such  a 
profusion  of  blessings  as  have  been  mentioned,  is  to 
imitate  the  conduct  of  the  man,  who,  in  attempting 
to  kill  a  fly  upon  his  child's  forehead,  knocked  out 
its  brains. 

From  the  detail  that  has  been  given  of  the  sources 
of  malignant  fevers,  and  of  the  means  of  preventing 
them,  it  is  evident  that  they  do  not  exist  by  an  un- 
changeable law  of  nature,  and  that  Heaven  has  sur- 
rendered every  part  of  the  globe  to  man,  in  a  state 
capable  of  being  inhabited,  and  enjoyed.  The  facts 
that  have  been  mentioned  show  further,  the  con- 
nection of  health  and  longevity,  with  the  reason  and 
labour  of  man. 

To  every  natural  evil  the  Author  of  Nature  has 
kindly  prepared  an  antidote.  Pestilential  fevers 
furnish  no  exception  to  this  remark.  The  means 
of  preventing  them  are  as  much  under  the  power 
of  human  reason  and  industry,  as  the  means  of 
preventing  the  evils  of  lightning  and  common  fire. 


220    ON    THE    MEANS    OF    PREVENTING,  &C. 

I  am  so  satisfied  of  the  truth  of  this  opinion,  that 
I  look  for  a  time  when  our  courts  of  law  shall 
punish  cities  and  villages,  for  permitting  any  of  the 
sources  of  bilious  and  malignant  fevers  to  exist 
within  their  jurisdiction. 

I  have  repeatedly  asserted  the  yellow  fever  of  the 
United  States  not  to  be  contagious.  I  shall  now 
mention  the  proofs  of  that  assertion,  and  endeavour 
to  explain  instances  of  its  supposed  contagion  upon 
other  principles. 


FACTS, 


INTENDED    TO    PROVE 


THE  TELLOW  FEVER 


NOT  TO  BE  CONTAGIOUS. 


FACTS,  &c. 


WHEN  fevers  are  communicated  from  one 
person  to  another,  it  is  always  in  one  of  the  follow- 
ing ways.  1.  By  secreted  matters.  2.  By  excreted 
matters.  The  small-pox  and  measles  are  commu- 
nicated in  the  former  way ;  the  jail,  or,  as  it  is  some- 
times called,  the  ship,  or  camp,  and  hospital  fever, 
is  communicated  only  by  means  of  the  excretions  of 
the  body.  The  perspiration,  by  acquiring  a  morbid 
and  irritating  quality  more  readily  than  any  other 
excretion,  in  consequence  of  its  stagnation  and  con- 
finement to  the  body  in  a  tedious  jail  fever,  is  the 
principal  means  of  its  propagation.  The  perspira- 
tion* is,  moreover,  predisposed  to  acquire  this  mor- 

*  The  deleterious  nature  of  this  fluid,  and  its  disposition 
to  create  disease,  under  the  above  circumstances,  has  been 
happily  illustrated  by  Dr.  Mitchill,  in  an  ingenious  letter  to 
Dr.  Duncan,  of  Edinburgh,  published  in  the  fourth  volume 
of  the  Annals  of  Medicine. 


224      YELLOW    FEVER    NOT    CONTAGIOUS. 

bid  and  acrid  quality  by  the  filthiness,  scanty,  or 
bad  aliment,  and  depression  of  mind,  which  gene- 
rally precede  that  fever.  It  is  confined  to  sailors, 
passengers,  soldiers,  prisoners,  and  patients,  in 
foul  and  crowded  ships,  tents,  jails,  and  hospitals, 
and  to  poor  people  who  live  in  small,  damp,  and 
confined  houses.  It  prevails  chiefly  in  cool  and 
cold  weather,  but  is  never  epidemic ;  for  the 
excreted  matters  which  produce  the  fever  do 
not  float  in  the  external  atmosphere,  nor  are  they 
communicated,  so  as  to  produce  disease,  more  than 
a  few  feet  from  the  persons  who  exhale  them. 
They  are  sometimes  communicated  by  means  of 
the  clothes  which  have  been  worn  by  the  sick,  and 
there  have  been  instances  in  which  the  fever  has 
been  produced  by  persons  who  had  not  been  con- 
fined by  it,  but  who  had  previously  been  exposed 
to  all  the  causes  which  generate  it.  It  has  been 
but  little  known  in  the  United  States  since  the  re- 
volutionary war,  at  which  time  it  prevailed  with  great 
mortality  in  the  hospitals  and  camps  of  the  Ameri- 
can army.  It  has  now  and  then  appeared  in  ships 
that  were  crowded  with  passengers  from  different 
parts  of  Europe.  It  is  a  common  disease  in  the 
manufacturing  towns  of  Great- Britain,  where  it  has 
been  the  subject  of  several  valuable  publications, 
particularly  by  Dr. .  Smith  and  Dr.  John  Hunter. 
Dr.  Hay  garth  has  likewise  written  upon  it,  but  he 


YELLOW    FEVER    WOT    CONTAGIOUS.      225 

has  unfortunately  confounded  it  with  the  West- 
India  and  American  yellow  fever,  which  differs 
from  it  in  prevailing  chiefly  in  warm  climates  and 
seasons ;  in  being  the  offspring  of  dead  and  putrid 
vegetable  and  animal  matters ;  in  affecting  chiefly 
young  and  robust  habits ;  in  being  generally  ac- 
companied with  a  diseased  state  of  the  stomach, 
and  an  obstruction  or  preternatural  secretion  and 
excretion  of  bile  ;  in  terminating,  most  commonly, 
within  seven  days ;  in  becoming  epidemic  only  by 
means  of  an  impure  atmosphere ;  and  in  noi  fur- 
nishing ordinarily  those  excretions  which,  when  re- 
ceived into  other  bodies,  re-produce  the  same  dis- 
ease. 

I  have  been  compelled  to  employ  this  tedious 
description  of  two  forms  of  fever,  widely  different 
from  each  other  in  their  causes,  symptoms,  and 
duration,  from  the  want  of  two  words  which  shall 
designate  them.  Dr.  Miller  has  boldly  and  inge- 
niously proposed  to  remedy  this  deficiency  in  our 
language,  by  calling  the  former  idio-miasmatic,  and 
the  latter  koino-miasmatic  fevers,  therebv  denoting 
their  private  or  personal,  and  their  public  or  com- 
mon  origin- .  My  best  wishes  attend  the  adoption 
of  those  terms ! 

*  Medical  Repository,  hexade  ii.  vol.  i. 
VOL.    IV.         .  2    F 


226      YELLOW    FEVER    NOT    CONTAGIOUS. 

I  return  to  remark,  that  the  yellow  fever  is  not. 
contagious  in  its  simple  state,  and  that  it  spreads 
exclusively  by  means  of  exhalations  from  putrid 
matters,  which  are  diffused  in  the  air.  This  is  evi- 
dent from  the  following  considerations: 

1.  It  does  not  spread  by  contagion  in  the  West- 
Indies.  This  has  been  proved  in  the  most  satis- 
factory manner  by  Drs.  Hillary,  Huck,  Hunter, 
Hector  M'Lean,  Clark,  Jackson,  Borland,  Pinck- 
ard,  and  Scott.  Dr.  Chisholm  stands  alone,  among 
modern  physicians,  in  maintaining  a  contrary  opi- 
nion. It  would  be  easy  to  prove,  from  many  pas- 
sages in  the  late  edition  of  the  doctor's  learned  and 
instructive  volumes,  that  he  has  been  mistaken ; 
and  that  the  disease  was  an  endemic  of  every  island 
in  which  he  supposed  it  to  be  derived  from  conta- 
gion. A  just  idea  of  the  great  incorrectness  of  all 
his  statements,  in  favour  of  his  opinion,  may  be 
formed  from  the  letter  of  J.  F.  Eckard,  Esq.  Da- 
nish consul,  in  Philadelphia,  to  Dr.  James  Mease, 
published  in  a  late  number  of  the  New- York  Me- 
dical  Repository*. 

*  For  February,  March,  and  April,  1$04. 


YELLOW    FEVER     NOT    CONTAGIOUS.      227 

2.  The  yellow  fever  does  not  spread  in  the  coun- 
try, when  carried  thither  from  the  cities  of  the 
United  States. 

3.  It  does  not  spread  in  yellow  fever  hospitals, 
when  they  are  situated  beyond  the  influence  of  the 
impure  air  in  which  it  is  generated. 

4.  It  does  not  spread  in  cities  (as  will  appear 
hereafter)  from  any  specific  matter  emitted  from 
the  bodies  of  sick  people. 

5.  It  generally  requires  the  co-operation  of  an 
exciting  cause,  with  miasmata,  to  produce  it. 
This  is  never  the  case  with  diseases  which  are  uni- 
versally acknowledged  to  be  contagious. 

6.  It  is  not  propagated  by  the  artificial  means 
which  propagate  contagious  diseases.  Dr.  Ffirth 
inoculated  himself  above  twenty  times,  in  different 
parts  of  his  body,  with  the  black  matter  discharged 
from  the  stomachs  of  patients  in  the  yellow  fever, 
and  several  times  with  the  serum  of  the  blood,  and 
the  saliva  of  patients  ill  with  that  disease,  without 
being  infected  by  them ;  nor  was  he  indisposed 
after  swallowing  half  an  ounce  of  the  black  matter 
recently  ejected  from  the  stomach,  nor  by  exposing 
himself  to  the  vapour   which  was  produced  by 


228      YELLOW    FEVER    NOT    CONTAGIOUS. 

throwing  a  quantity  of  that  matter  upon  iron  heated 
over  a  fire*. 

To  the  first  four  of  these  assertions  there  are 
some  seeming  exceptions  in  favour  of  the  propaga- 
tion of  this  fever  by  contagion.  I  shall  briefly 
mention  them,  and  endeavour  to  explain  them  up- 
on other  principles. 

The  circumstances  which  seem  to  favour  the 
communication  of  the  yellow  fever  from  one  person 
to  another,  by  means  of  what  has  been  supposed  to 
be  contagion,  are  as  follow  : 

1.  A  patient  being  attended  in  a  small,  filthy,  and 
close  room.  The  excretions  of  the  body,  when  thus 
accumulated,  undergo  an  additional  putrefactive  pro- 
cess, and  acquire  the  same  properties  as  those  putrid 
animal  matters  which  are  known  to  produce  malig- 
nant fevers.  I  have  heard  of  two  or  three  instances 
in  which  a  fever  was  produced  by  these  means  in 
the  country,  remote  from  the  place  where  it  origi- 
nated, as  well  as  from  every  external  source  of  pu- 
trid exhalation.  The  plague  is  sometimes  propa- 
gated in  this  way  in  the  low  and  filthy  huts  which 

*  Inaugural  Dissertation  on  Malignant  Fever,  Sec.  pub- 
lished in  June,  1804. 


YELLOW    FEVER    NOT    CONTAGIOUS.      229 

compose  the  alleys  and  narrow  streets  of  Cairo, 
Smyrna,  and  Constantinople. 

2.  A  person  sleeping  in  the  sheets,  or  upon  a  bed 
impregnated  with  the  sweats  or  other  excretions,  or 
being  exposed  to  the  smell  of  the  foul  linen,  or  other 
clothing  of  persons  who  had  the  yellow  fever. 
The  disease  here,  as  in  the  former  case,  is  commu- 
nicated in  the  same  way  as  from  any  other  putrid 
animal  matters.  It  was  once  received  in  Philadel- 
phia from  the  effluvia  of  a  chest  of  unwashed  clothes, 
which  had  belonged  to  one  of  our  citizens  who  had 
died  with  it  in  Barbadoes ;  but  it  extended  no  fur- 
ther in  a  large  family  than  to  the  person  who  open- 
ed the  chest.  I  have  heard  of  but  two  instances 
more  of  its  having  been  propagated  by  these  means 
in  the  United  States,  in  which  case  the  disease  pe- 
rished with  the  unfortunate  subjects  of  it. 

To  the  above  insolated  cases  of  the  yellow  fever 
being  produced  by  the  clothing  of  persons  who  had 
died  of  it,  I  shall  oppose  a  fact  communicated  to 
me  by  Dr.  Mease.  While  the  doctor  resided  at 
the  lazaretto,  as  inspector  of  sickly  vessels,  be- 
tween May,  1794,  and  the  same  month  in  1798, 
the  clothing  contained  in  the  chests  and  trunks  of 
all  the  seamen  and  others,  belonging  to  Philadel- 
phia, who  had  died  of  the  yellow  fever  in  the  West- 


230      YELLOW    FEVER    NOT    CONTAGIOUS. 

Indies,  or  on  their  passage  home,  and  the  linen  of 
all  the  persons  who  had  been  sent  from  the  city 
to  the  lazaretto  with  that  disease,  amounting  in  all 
to  more  than  one  hundred,  were  opened,  exposed 
to  the  air,  and  washed,  by  the  family  of  the  steward 
of  the  hospital,  and  yet  no  one  of  them  contracted 
the  least  indisposition  from  them. 

I  am  disposed  to  believe  the  linen,  or  any  other 
clothing  of  a  person  in  good  health  that  had  been 
strongly  impregnated  with  sweats,  and  afterwards 
suffered  to  putrify  in  a  confined  place,  would  be 
more  apt  to  produce  a  yellow  fever  in  a  summer  or 
autumnal  month,  than  the  linen  of  a  person  who  had 
died  of  that  disease,  with  the  usual  absence  of  a 
moisture  on  the  skin.  The  changes  which  the 
healthy  excretions  by  the  pores  undergo  by  pu- 
trefaction, may  easily  be  conceived,  by  recollecting 
the  offensive  smell  which  a  pocket-handkerchief  ac- 
quires that  has  been  used  for  two  or  three  days  to 
wipe  away  the  sweat  of  the  face  and  hands  in  warm 
weather*. 

3.  The  protraction  of  a  yellow  fever  to  such  a 
period  as  to  dispose  it  to  assume  the  symptoms,  and 
to  generate  the  peculiar  and  highly  volatilised  ex- 

*  See  Van  Swieten  on  Epidemic  Diseases,  Aphorism  1408. 


YELLOW    FEVER    NOT    CONTAGIOUS.      231 

halation  from  the  pores  of  the  skin  which  takes 
place  in  the  jail  fever.  I  am  happy  in  finding  I  am 
not  the  author  of  this  opinion.  Sir  John  Pringle, 
Dr.  Monro,  and  Dr.  Hillary,  speak  of  a  contagious 
fever  produced  by  the  combined  action  of  marsh 
and  human  miasmata.  The  first  of  those  physicians 
supposes  the  Hungarian  bilious  fever,  which  prevail- 
ed over  the  continent  of  Europe  in  the  seventeenth 
century,  was  sometimes  propagated  in  this  way,  as 
well  as  by  marsh  and  other  putrid  exhalations. 
Dr.  Richard  Pearson,  in  his  observations  upon  the 
bilious  fevers  which  prevailed  in  the  neighbourhood 
of  Birmingham,  in  England,  in  the  years  1797, 
1798,  and  1799,  has  the  folllowing  remark  :  "  In 
its  first  stage,  this  fever  did  not  appear  to  be  conta- 
gious, but  it  evidently  was  so  after  the  eleventh  and 
fourteenth  day,  when  the  typhoid  state  was  in- 
duced*." As  this  protracted  state  of  bilious  fever 
rarely  occurs  in  our  country,  it  has  seldom  been 
communicated  in  this  way. 

It  is  not  peculiar,  I  believe,  to  a  bilious  and  yel- 
low fever,  when  much  protracted  beyond  its  ordi- 
nary duration,  to  put  on  the  symptoms  of  the  jail 
fever.    The  same  appearances  occur  in  the  pleurisy, 

"*Page  13. 


232      YELLOW    FEVER    NOT    CONTAGIOUS. 

and  in  other,  of  what  Dr.  Sydenham  calls  intercur- 
rent fevers,  all  of  which  I  have  no  doubt,  under  cer- 
tain circumstances  of  filth,  confinement,  and  long  du- 
ration, would  produce  a  fever  in  persons  who  were 
exposed  to  it.  This  fever,  if  the  weather  were 
cold,  would  probably  put  on  inflammatory  symp- 
toms, and  be  added,  in  our  nosologies,  to  the  class 
of  contagious  diseases. 

From  the  necessary  influence  of  time,  in  thus 
rendering  fevers  of  all  kinds  now  and  then  conta- 
gious by  excretion,  it  follows,  that  the  yellow  fever, 
when  of  its  usual  short  duration,  is  incapable  of 
generating  that  excretion,  and  that,  instead  of  be- 
ins:  considered  as  the  onlv  form  of  bilious  fever  that 
possesses  a  power  of  propagating  itself,  it  should 
be  considered  as  the  only  one  that  is  devoid  of  it. 

4.  Miasmata,  whether  from  marshes,  or  other 
external  sources,  acting  upon  a  system  previously 
impregnated  with  the  excreted  matters  which  pro- 
duce the  jail  or  ship  fever.  Mr.  Lempriere  informs 
us,  that  he  saw  what  were  supposed  to  be  cases  of 
yellow  fever  communicated  by  some  sailors  who 
brought  the  seeds  of  the  ship  fever  with  them  to 
the  island  of  Jamaica.  The  fevers  which  affected 
most  of  the  crews  of  the  Hussar  frigate,  mentioned 


YELLOW    FEVER    NOT    CONTAGIOUS.      233 

by  Dr.  Trotter*,  and  of  the  Busbridge  Indiaman, 
described  by  Mr.  Brycef ,  appear  to  have  been  the 
effect  of  the  combined  operation  of  foul  air  in  those 
ships,  and  human  excretions,  upon  their  systems. 
The  disease  was  barely  tinged  with  bilious  symp- 
toms, and  hence  the  facility  with  which  it  was  cured, 
for  the  jail  fever  more  readily  yields  to  medicine 
than  the  yellow  fever.  The  former  was  probably 
excited  by  some  latent  exhalation  from  dead  mat- 
ters in  the  holds  of  the  ships,  and  hence  we  find  it 
ceased  on  shore,  where  it  was  deprived  of  its  ex- 
citing cause.  It  is  true,  great  pains  were  taken  to 
clean  the  hold  and  decks  of  the  Busbridge,  but 
there  are  foul  matters  which  adhere  to  the  timbers 
of  ships,  and  which,  according  to  Dr.  Lind,  are 
sometimes  generated  by  those  timbers  when  new, 
that  are  not  to  be  destroyed  by  any  of  the  common 
means  employed  for  that  purpose.  Of  this  Dr. 
Kollock  has  furnished  us  with  a  most  satisfactory 
proof,  in  his  history  of  the  yellow  fever,  which 
prevailed  on  board  of  the  frigate  General  Greene, 
on  her  voyage  to  the  Havanna,  in  the  year  1799. 
"  The  air  in  the  hold  of  the  vessel  (says  the  doctor) 
was  so  contaminated,  as  to  extinguish  lights  imme- 

*  Medicina  Nautica,  p.  360. 

t  Annals  of  Medicine,  vol.  i.  p.  116. 
VOL.    IV.  2  G 


234      YELLOW    FEVER     NOT    CONTAGIOUS. 

diately,  and  candles  in  the  cockpit  were  almost  as 
useless  from  the  same  cause.  The  fish  were  thrown 
overboard,  and  the  decks  washed  and  scoured,  the 
ventilator  and  wind  sails  put  in  motion,  and  every 
measure  of  purification  adopted  that  their  situation 
allowed  ;  notwithstanding  these  precautions  disease 
invaded  us.  The  men  were  unceasing  in  their 
exertions  to  purify  the  ship ;  washing,  scouring 
with  vinegar,  burning  powder  and  vinegar,  old 
junk,  and  sulphur,  added  to  constant  ventilation, 
proved  unequal  even  to  the  amelioration  of  their 
calamities,  while  they  were  in  the  latitude  of  great 
heat.  After  the  removal  of  the  sick,  the  ship  was 
disburthened  of  her  stores,  ballast,  8cc.  cleansed 
and  white- washed  throughout ;  still  new  eases  oc- 
curred for  nearly  two  months.  Some  days,  two, 
three,  or  four  were  sent  off  to  the  hospital,  which 
would  seem  to  indicate  the  retention  of  some  por- 
tion of  this  noxious  principle,  which  was  lodged 
beyond  the  reach  of  the  cleansing  process."  That 
this  noxious  principle  or  matter  existed  in  the  ship, 
and  not  in  the  bodies  of  the  crew,  is  evident  from 
its  not  having  been  communicated,  in  a  single  in- 
stance, by  a  hundred  of  them  who  were  sent  to  an 
hospital  on  Rhode- Island,  notwithstanding  an  inter- 
course sufficient  to  propagate  it  was  necessarily 


YELLOW    FEVER    NOT    CONTAGIOUS.      235 

kept  up  with  the  inhabitants.     Even  their  nurses 
did  not  take  it*. 

5.  A  fifth  instance  in  which  contagion  has  been 
supposed  to  take  place  in  the  yellow  fever  is,  where 
the  exhalation  from  the  excretions  of  a  patient  in 
that  disease  acts  as  an  exciting  cause,  in  persons 
previously  impregnated  with  the  marsh,  or  other 
external  miasmata,  which  produce  it.  The  acti- 
vity of  this  exhalation,  even  when  it  is  attended 
with  no  smell,  is  so  great,  as  to  induce  sickness, 
head-ach,  vertigo,  and  fainting.  It  is  not  peculiar 
to  the  exhalations  from  such  patients  to  produce 
morbid  effects  upon  persons  who  visit  them.  The 
odour  emitted  by  persons  in  the  confluent  small- 
pox has  been  known  to  produce  the  same  symp- 
toms, together  with  a  subsequent  fever  and  apthous 
sore  throat.  This  has  been  remarked  long  ago  by 
Dr.  Lind,  and  latterly  by  Dr.  Willan,  in  his  Re- 
ports of  the  Diseases  of  Londonf.  That  the  yellow 
fever  is  often  excited  in  this  way,  without  the  inter- 
vention of  a  supposed  specific  contagion,  I  infer 
from  its  sometimes  spreading  through  whole  fami- 
lies, who  have  breathed  the  same  impure  atmo- 
sphere with  the  person  first  infected  by  the  fever. 

*  Medical  Repository,  vol.  iv.  No.  1. 
f-  Page  13  and  113. 


236      YELLOW    FEVER    NOT    CONTAGIOUS. 

This  is  more  especially  the  case  where  the  impres- 
sion made  by  the  exhalation  from  the  sick  person 
is  assisted  by  fear,  fatigue,  or  anxiety  of  mind  in 
other  branches  of  the  family.  In  favour  of  this 
mode  of  exciting  the  yellow  fever,  Dr.  Otto  com- 
municated to  me  the  following  fact.  In  the  au- 
tumn of  the  year  1798,  it  prevailed  upon  the  shores 
of  the  Delaware,  in  Gloucester  county,  in  New- 
Jersey.  A  mild  remittent  prevailed  at  the  same 
time  on  the  high  grounds,  a  few  miles  from  the 
river.  During  this  time,  the  doctor  observed,  if  a 
person  who  had  inhaled  the  seeds  of  the  yellow  fe- 
ver in  Philadelphia  afterwards  came  into  a  family 
near  the  river,  the  same  disease  appeared  in  several 
instances  in  one  or  more  branches  of  that  family ; 
but  where  persons  brought  the  fever  from  the  city, 
and  went  into  a  family  on  the  high  grounds,  where 
the  mild  remittents  prevailed,  there  was  not  a  sin- 
gle instance  of  a  yellow  fever  being  excited  by  them 
in  any  of  its  members.  This  fact  is  important, 
and  of  extensive  application.  It  places  the  stimu- 
lus from  the  breath,  or  other  exhalations  of  persons 
affected  by  the  yellow  fever,  upon  a  footing  with 
intemperance,  fatigue,  heat,  and  all  the  common 
exciting  causes  of  the  disease  ;  none  of  which,  it  is 
well  known,  can  produce  it,  except  in  persons  who 
have  previously  inhaled  the  putrid  miasmata,  which 
in  all  countries  are  its  only  remote  cause.     The 


YELLOW    FEVER    NOT    CONTAGIOUS.      237 

city  of  Philadelphia  has  furnished,  in  all  our  yellow 
fever  years,  many  additional  proofs  of  the  correct- 
ness of  Dr.  Otto's  remark.  In  the  months  of  July 
and  August,  when  miasmata  are  generally  local, 
and  float  chiefly  near  to  their  hot  beds,  the  docks 
and  holds  of  ships,  persons  who  are  affected  by 
these  miasmata,  and  sicken  in  other  parts  of  the 
city,  never  communicate  the  disease  ;  but  after  the 
less  prepared  and  heterogeneous  filth  of  our  whole 
city  has  been  acted  on  by  an  autumnal,  as  well 
as  summer  sun,  so  as  to  emit  pestilential  exhala- 
tions into  all  our  streets  and  alleys,  the  fever  is  now 
and  then  excited  in  the  manner  that  has  been  men- 
tioned, by  a  single  person  in  a  whole  family.  The 
common  intermittents  of  the  southern  states  are 
often  excited  in  the  same  way,  without  being  sus- 
pected of  spreading  by  contagion.  Even  the  jail 
or  hospital  fever  is  vindicated  by  Dr.  Hunter  from 
the  highly  contagious  nature  which  has  been  as- 
cribed to  it,  upon  the  same  principle.  His  words, 
which  are  directly  to  my  purpose,  are  as  follow : 
cc  In  considering  the  extent  and  power  of  the  con- 
tagion [meaning  of  the  jail  or  hospital  fever],  I  am 
not  inclined  to  impute  to  this  cause  the  fevers  of 
all  those  who  are  taken  ill  in  one  family  after  the 
first,  as  they  are  all  along  exposed  to  the  same  vi- 
tiated air  which  occasions  the  first  fever.  In  like 
manner,  when  a  poor  woman  visits  some  of  her 


238      YELLOW    FEVER    NOT    CONTAGIOUS. 

sick  neighbours,  and  is  taken  ill  herself,  and  after- 
wards some  of  her  children,  I  would  not  impute  the 
disease  to  infection  alone ;  she  and  her  family  hav- 
ing previously  lived  in  the  same  kind  of  vitiated  air 
which  originally  produced  the  fever.  If  the  cases 
in  which  the  infection  meets  with  the  poison  al- 
ready half  formed  be  excepted,  the  disease  in  itself 
will  be  found  to  be  much  less  infectious  than  has 
been  commonly  supposed*."  By  the  modes  of 
communicating  the  yellow  fever  which  have  been 
admitted,  the  dysentery,  and  all  the  milder  forms  of 
autumnal  fevers,  have  been  occasionally  propagated, 
and  perhaps  oftener  than  the  first- named  disease, 
from  their  being  more  apt  to  run  on  to  the  typhus  or 
chronic  state.  Of  this  I  could  adduce  many  proofs, 
not  only  from  books,  but  from  my  own  observa- 
tions ;  but  none  of  these  diseases  spread  by  conta- 
gion, or  become  epidemic  from  that  cause  in  any 
country.  A  contrary  opinion,  I  know,  is  held  by 
Dr.  Cleghorn,  and  Dr.  Clarke  ;  but  they  have  de- 
ceived themselves,  as  they  formerly  deceived  me, 
by  not  attending  to  the  difference  between  secreted 
contagions  and  morbid  excretions  from  the  body, 
produced  by  the  causes  which  have  been  enumer- 
ated, and  which  are  rare  and  accidental  concomi- 
tants of  bilious  or  summer  diseases. 

*  Medical  Transactions,  vol.  iii-  p.  351. 


BELLOW    FEVER    NOT    CONTAGIOUS.       239 

6.  The  last  instance  of  supposed  contagion  of 
the  yellow  fever  is  said  to  arise  from  the  effluvia  of 
a  putrid  body  that  has  died  of  that  disease.  The 
effluvia  in  this  case  act  either  as  the  putrified  ex- 
cretions mentioned  under  the  first  head,  or  as  an 
exciting  cause  upon  miasmata,  previously  received 
into  the  system.  A  dead  body,  in  a  state  of  putre- 
faction from  any  other  disease,  would  produce,  un- 
der the  same  circumstances  of  season  and  predispo- 
sition, the  same  kind  and  degrees  of  fever. 

The  similarity  of  the  fever  induced  by  the  means 
that  have  been  enumerated,  with  the  fever  from 
which  it  was  derived,  has  been  supposed  to  favour 
the  opinion  of  its  being  communicated  by  a  speci- 
fic contagion.  But  let  it  be  recollected  that  the 
yellow  fever  is,  at  the  time  of  its  being  supposed 
to  be  thus  received,  the  reigning  epidemic,  and 
that  irritants  of  all  kinds  necessarily  produce  that 
disease.  The  morbid  sweats  which  now  and  then 
produce  an  intermitting  fever,  and  the  alvine  ex- 
cretions which  occasionally  produce  a  dysentery, 
act  only  by  exciting  morbid  actions  in  the  system, 
which  conform  in  their  symptoms  to  an  immutable 
and  universal  law  of  epidemics.  It  is  only  when 
those  two  diseases  generally  prevail,  that  they  seem 
to  produce  each  other. 


240      YELLOW    FEVER    NOT    CONTAGIOUS. 

Thus  have  I  explained  all  the  supposed  cases  of 
f  ontagion  of  the  yellow  fever.  To  infer  from  the 
solitary  instances  of  it  thus  excited,  is  to  reason  as 
incorrectly  as  to  say  the  small-pox  is  not  contagious, 
because  we  now  and  then  meet  with  persons  whe 
cannot  be  infected  by  it. 

From  the  explanation  that  has  been  given  of  the 
instances  of  supposed  contagion  of  the  yellow  fe- 
ver, we  are  compelled  to  resort  to  certain  noxious 
qualities  in  the  atmosphere,  as  the  exclusive  causes 
of  the  prevalence,  not  only  of  that  fever,  but  (with 
a  few  exceptions)  of  all  other  epidemic  diseases. 
It  is  true,  we  are  as  yet  ignorant  of  the  precise 
nature  of  those  qualities  in  the  air  which  produce 
epidemics  ;  but  their  effects  are  as  certainly  felt  by 
the  human  body  as  the  effects  of  heat,  and  yet  who 
knows  the  nature  of  that  great  and  universal  prin- 
ciple of  activity  in  our  globe  ? 

That  the  yellow  fever  is  propagated  by  means  of 
an  impure  atmosphere,  at  all  times,  and  in  all  places, 
I  infer  from  the  following  facts  : 

1.  It  appears  only  in  those  climates  and  seasons 
of  the  year  in  which  heat,  acting  upon  moist  ani- 
mal and  vegetable  matters,  fills  the  air  with  their 
putrid  exhalations.     A  vertical  sun,  pouring  its 


YELLOW    FEVER    NOT    CONTAGIOUS.      241 

beams  for  ages  upon  a  dry  soil ;  and  swamps,  de- 
fended from  the  influence  of  the  sun  by  extensive 
forests,  have  not,  in  a  single  instance,  produced 
this  disease. 

2.  It  is  unknown  in  places  where  a  connection 
is  not  perceptible  between  it,  and  marshes,  mill- 
ponds,  docks,  gutters,  sinks,  unventilated  ships, 
and  other  sources  of  noxious  air.  The  truth  of 
this  remark  is  established  by  the  testimonies  of 
Dr.  Lind  and  Dr.  Chisholm,  and  by  many  facts  in 
Lempriere's  excellent  History  of  the  Diseases  of 
Jamaica.  Dr.  Davidson  furnished  me  with  a  strik- 
ing confirmation  of  their  remarks,  in  the  following 
extract  from  a  letter,  dated  November  12th,  1794. 
"  I  have  mentioned  (says  the  doctor)  an  instance 
of  the  remarkable  good  health  which  the  66th  re- 
giment enjoyed  at  St.  Vincents  for  several  years, 
upon  a  high  hill  above  the  town,  removed  from  all 
exhalations,  and  in  a  situation  kept  at  all  times  cool 
by  the  blowing  of  a  constant  trade  wind.  They 
did  not  lose,  during  eighteen  months,  above  two 
or  three  men  (the  regiment  -was  completed  to  the 
peace  establishment),  and  during  eight  years  they 
lost  but  two  officers,  one  of  whom,  the  quarter- 
master, resided  constantly  in  town,  and  died  from 
over  fatigue  ;  the  other  arrived  very  ill  from  An- 
tigua, and  died  within  a  few  days  afterwards." 

vol.  iv.  2  h 


242      YELLOW    FEVER    NOT    CONTAGIOUS. 

In  the  United  States,  no  advocate  for  the  speci- 
fic nature  or  importation  of  the  yellow  fever,  has 
ever  been  able  to  discover  a  single  case  of  it  beyond 
the  influence  of  an  atmosphere  rendered  impure  by 
putrid  exhalations. 

It  is  no  objection  to  the  truth  of  this  remark, 
that  malignant  bilious  fevers  sometimes  appear  up- 
on the  summits  of  hills,  while  their  declivities,  and 
the  vallies  below,  are  exempted  from  them.  The 
miasmata,  in  all  these  cases,  are  arrested  by  those 
heights,  and  are  always  to  be  traced  to  putrefaction 
and  exhalation  in  their  neighbourhood.  Nor  is  it 
any  objection  to  the  indissoluble  connection  be- 
tween putrid  exhalations  and  the  yellow  fever, 
which  has  been  mentioned,  that  the  disease  some- 
times appears  in  places  remote  from  the  source  of 
miasmata  in  time  and  place.  The  bilious  pleuri- 
sies, which  occur  in  the  winter  and  spring,  after  a 
sickly  autumn,  prove  that  they  are  retained  in  th§ 
body  for  many  months,  and  although  they  are 
sometimes  limited  in  their  extent  to  a  single  house, 
and  often  to  a  village,  a  city,  and  the  banks  of  a 
creek  or  river,  yet  they  are  now  and  then  carried 
to  a  much  greater  distance.  Mr.  Lempriere,  in 
his  valuable  Observations  upon  the  Diseases  of  the 
British  Army  in  Jamaica,  informs  us,  that  Kings- 
ton is  sometimes  rendered  sickly  by  exhalations 


YELLOW    FEVER    NOT    CONTAGIOUS.      243 

from  a  lagoon,  which  lies  ?iine  miles  to  the  east- 
ward of  that  town*.  The  greater  or  less  distance, 
to  which  miasmata  are  carried  from  the  place 
where  they  are  generated,  appears  to  depend  upon 
their  quantity,  upon  the  force  and  duration  of  cur- 
rents of  wind  which  act  upon  them,  and  upon  their 
being  more  or  less  opposed  by  rivers,  woods,  wa- 
ter, houses,  wells,  or  mountains. 

3.  It  is  destroyed,  like  its  fraternal  diseases,  the 
common  bilious  and  intermitting  fevers,  by  means 
of  long- continued  and  heavy  rainsf .  When  rains 
are  heavy,  but  of  short  duration,  they  suspend  it 
only  in  warm  weather ;  but  when  they  are  suc- 
ceeded by  cold  weather,  they  destroy  all  the  forms 
of  bilious  fever.  The  malignant  tertians,  described 
by  Dr.  Cleghorn,  always  ceased  about  the  autum- 
nal equinox ;  for  at  that  time,  says  the  doctor, 
"  Rain  falls  in  such  torrents  as  to  tear  up  trees  by 
the  roots,  carry  away  cattle,  break  down  fences, 
and  do  considerable  mischief  to  the  gardens  and 
vineyards ;  but,  after  a  long  and  scorching  sum- 
mer, they  are  very  acceptable  and  beneficial,  for 
they  mitigate  the  excessive  heat  of  the  air,  and  give 

*  Vol.  i.  p.  84. 

t  Clarke  on  the  Diseases  of  Long  Voyages  to  Hot  Cli- 
mates, p.  116. 


244      YELLOW    FEVER    NOT    CONTAGIOUS. 

a  check  to  epidemical  diseases*."  There  are  facts, 
however,  which  would  seem  to  contradict- the  as- 
sertion that  miasmata  are  suspended  or  destroyed 
by  heavy  rains.  Dr.  Lind,  in  his  Treatise  upon 
the  Diseases  of  Hot  Climates,  mentions  instances 
in  which  they  suddenly  created  fevers.  It  is  proba- 
ble, in  these  cases  the  rains  may  have  had  that  effect, 
by  disturbing  the  pellicle  which  time  often  throws 
over  the  surface  of  stagnating  pools  of  water,  and 
putrid  matters  on  dry  land.  I  was  led  to  entertain 
this  opinion  by  a  fact  mentioned  in  a  letter  I  re- 
ceived from  Dr.  Davidson,  dated  November  4th, 
1794.  "  Being  ordered  (says  the  doctor)  up  to 
Barbadoes,  last  November,  upon  service,  I  found 
that  the  troops  had  suffered  considerably  by  that 
formidable  scourge,  the  yellow  fever.  The  season 
had  been  remarkably  dry.  It  was  observed,  a  rainy 
season  contributed  to  make  the  season  healthier, 
excepting  at  Constitution- Hill,  where  the  sixth  re- 
giment was  stationed,  and  where  a  heavy  shower 
of  rain  seldom  failed  to  bring  back  the  fever,  after 
it  had  ceased  for  some  time.  I  found  the  barrack, 
where  this  regiment  was,  surrounded  by  a  pond  of 
brackish  water,  which,  being  but  imperfectly  drain- 
ed by  the  continuance  of  the  drought,  the  surface 
was  covered  with  a  green  scum,  which  prevented 

*  Diseases  of  Minorca,  p.  8. 


YELLOW    FEVER    NOT    CONTAGIOUS.      245 

the  exhalation  of  marshy  putrefaction.  After  a 
heavy  shower  of  rain,  this  scum  was  broken,  and 
the  miasmata  evolved,  and  acted  with  double  force, 
according  to  the  time  of  their  secretion,' ' 

4.  It  is  completely  destroyed  by  frost.  As 
neither  rains  nor  frosts  act  in  sick  rooms,  nor  af- 
fect the  bodies  of  sick  people,  they  must  annihilate 
the  disease  by  acting  exclusively  upon  the  atmo- 
sphere. Very  different  in  their  nature  are  the 
small-pox  and  measles,  which  are  propagated  by 
specific  contagion.  They  do  not  wait  for  the  suns 
of  July  or  August,  nor  do  they  require  an  impure 
atmosphere,  or  an  exciting  cause,  to  give  them  ac- 
tivity. They  spread  in  the  winter  and  spring,  as 
well  as  in  the  summer  and  autumnal  months  :  wet 
and  dry  weather  do  not  arrest  their  progress,  and 
frost  (so  fatal  to  the  yellow  fever),  by  rendering  it 
necessary  to  exclude  cold  air  from  sick  rooms, 
increases  the  force  of  their  contagion,  and  thereby 
propagates  them  more  certainly  through  a  country. 

5.  It  is  likewise  destroyed,  by  intense  heat,  and 
high  winds.  The  latter,  we  are  sure,  like  heavy 
rains  and  frost,  do  not  produce  that  salutary  effect 
by  acting  upon  the  bodies,  or  in  the  rooms  of  sick 
people. 


246      YELLOW    FEVER    NOT    CONTAGIOUS. 

It  is  worthy  of  notice,  that  while  the  activity  of 
miasmata  is  destroyed  by  cold,  when  it  descends  to 
frost ;  by  heat,  when  it  is  so  intense  as  to  dry  up 
all  the  sources  of  putrid  exhalation ;  by  heavy  rains, 
when  they  are  succeeded  by  cool  weather  ;  and  by 
high  winds,  when  they  are  not  succeeded  by  warm 
weather ;  they  are  rendered  more  active  by  cool, 
warm,  and  damp  weather,  and  by  light  winds. 
The  influence  of  damp  weather,  in  retaining  and 
propagating  miasmata,  will  be  readily  admitted,  by 
recollecting  how  much  more  easily  hounds  track 
their  prey,  and  how  much  more  extensively  odours 
of  all  kinds  pervade  the  atmosphere,  when  it  is 
charged  with  moisture,  than  in  dry  weather. 

It  has  been  asked,  if  putrid  matters  produce 
malignant  bilious  fevers  in  our  cities,  why  do  they 
not  produce  them  in  Lisbon,  and  in  several  other 
of  the  filthiest  cities  in  the  south  of  Europe  ?  To 
this  I  answer,  that  filth  and  dirt  are  two  distinct 
things.  The  streets  of  a  city  may  be  very  dirty, 
that  is,  covered  with  mud  composed  of  inoffensive 
clay,  sand,  or  lime,  and,  at  the  same  time,  be  per- 
fectly free  from  those  filthy  vegetable  and  animal 
matters  which,  by  putrefaction,  contaminate  the 
air.  But,  admitting  the  streets  of  those  cities  to 
abound  with  the  filthy  matters  that  produce  pesti- 
lential diseases  in  other  countries,  it  is  possible  the 


YELLOW    FEVER    NOT    CONTAGIOUS.      247 

exhalations  from  them  may  be  so  constant,  and  so 
powerful,  in  their  impressions  upon  the  bodies  of 
the  inhabitants,  as  to  produce,  from  habit,  no  mor- 
bid effects,  or  but  feeble  diseases,  as  was  re- 
marked formerly,  is  the  case  in  the  natives  and  old 
settlers  in  the  East  and  West- Indies.  But  if  this 
explanation  be  not  satisfactory,  it  may  be  resolved 
into  a  partial  absence  of  an  inflammatory  constitu- 
tion of  the  air,  which,  I  shall  say  presently,  must 
concur  in  producing  pestilential  diseases.  Such 
deviations  from  uniformity  in  the  works  of  Nature 
are  universal.  In  the  present  instances,  they  no 
more  invalidate  the  general  proposition  of  malignant 
fevers  being  every  where  of  domestic  origin,  than 
the  exemption  of  Ireland  from  venomous  reptiles, 
proves  they  are  not  generated  in  other  countries, 
or  that  the  pleurisy  and  rheumatism  are  not  the 
effects  of  the  alternate  action  of  cold  and  heat  upon 
the  body,  because  hundreds,  who  have  been  ex- 
posed to  them  under  equal  circumstances,  have  not 
been  affected  by  those  diseases.  There  may  be 
other  parts  of  the  world  in  which  putrid  matters  do 
not  produce  bilious  malignant  diseases  from  the 
causes  that  have  been  mentioned,  or  from  some 
unknown  cause,  but  I  am  safe  in  repeating,  there 
never  was  a  bilious  epidemic  yellow  fever  that  could 
not  be  traced  to  putrid  exhalation . 


248      YELLOW    FEVER    NOT    CONTAGIOUS, 

It  has  been  asked,  if  the  yellow  fever  be  not  im- 
ported, why  does  it  make  its  first  appearance  among 
sailors,  and  near  the  docks  and  wharves  of  our 
cities?  I  answer,  this  is  far  from  being  true. 
The  disease  has  as  often  appeared  first  at  a  distance 
from  the  shores  of  our  cities  as  near  them,  but, 
from  its  connection  with  a  ship  not  being  disco- 
vered, it  has  been  called  by  another  name.  But 
where  the  first  cases  of  it  occur  in  sailors,  I  believe 
the  seeds  of  it  are  always  previously  received  by 
them  from  our  filthy  docks  and  wharves,  or  from 
the  foul  air  which  is  discharged  with  the  cargoes 
of  the  ships  in  which  they  have  arrived,  which  seeds 
are  readily  excited  in  them  by  hard  labour,  or  in- 
temperance, so  as  to  produce  the  disease.  That 
this  is  the  case,  is  further  evident  from  its  appearing 
in  them,  only  in  those  months  in  which  the  bilious 
fever  prevails  in  our  cities. 

It  has  been  asked  further,  why  were  not  these 
bilious  malignant  fevers  more  common  before  the 
years  1791,  1792,  and  1793  ?  To  this  I  answer, 
by  repeating  what  was  mentioned  in  another  place*, 
that  our  climate  has  been  gradually  undergoing  a 
change.  The  summers  are  more  alternated  by  hot 
and  cool,  and  wet  and  dry  weather,  than  in  former 

*  Account  of  the  Climate  of  Pennsylvania,  vol  i. 


YELLOW    FEVER    NOT    CONTAGIOUS.      249 

years.  The  winters  are  likewise  less  uniformly 
cold.  Grass  is  two  or  three  weeks  later  in  the 
spring  in  affording  pasture  to  cattle  than  it  was 
within  the  memory  of  many  thousand  people. 
Above  all,  the  summer  has  encroached  upon  the 
autumn,  and  hence  the  frequent  accounts  we  read 
in  our  newspapers  of  trees  blossoming,  of  full  grown 
strawberries  and  raspberries  being  gathered,  and  of 
cherries  and  apples,  of  a  considerable  size,  being 
seen,  in  the  months  of  October  and  November,  in 
all  the  middle  states.  By  means  of  this  protraction 
of  the  heat  of  summer,  more  time  is  given  for  the 
generation  of  putrid  exhalations,  and  possibly  for 
their  greater  concentration  and  activity  in  producing 
malignant  bilious  diseases. 

It  has  been  asked  again,  why  do  not  the  putrid 
matters  which  produce  the  yellow  fever  in  some 
years  produce  it  every  year  ?  This  question  might 
be  answered  by  asking  two  others.  1st.  Why,  if 
the  yellow  fever  be  derived  from  the  West- Indies, 
was  it  not  imported  every  year  before  1791,  and 
before  the  existence,  or  during  the  feeble  and  partial 
operation  of  quarantine  laws  ?  It  is  no  answer  to 
this  question  to  say,  that  a  war  is  necessary  to  ge- 
nerate the  disease  in  the  islands,  for  it  exists  in 
some  of  them  at  all  times,  and  the  seasons  of  its 
prevalence  in  our  cities  have,  in  many  instances, 

vol.   iv.  2  I 


250      YELLOW    FEVER    NOT    CONTAGIOUS. 

had  no  connection  with  war,  nor  with  the  presence 
of  European  armies  in  those  and  in  other  sickly 
parts  of  the  globe.  During  the  seven  years  revo- 
lutionary war  it  was  unknown  as  an  epidemic  in  the 
United  States,  and  yet  sailors  arrived  in  all  our 
cities  daily  from  sickly  islands,  in  small  and  crowd- 
ed vessels,  and  sometimes  covered  with  the  rags 
they  had  worn  in  the  yellow  fever,  in  British  hos- 
pitals and  jails.  I  ask,  2dly,  why  does  the  dysen- 
tery (which  is  certainly  a  domestic  disease)  rise  up 
in  our  country,  and  spread  sickness  and  death 
through  whole  families  and  villages,  and  disappear 
from  the  same  places  for  fifteeen  or  twenty  years 
afterwards  ? 

The  want  of  uniformity  in  the  exhalations  of  our 
country  in  producing  those  diseases  depends  upon 
their  beino;  combined  with  more  or  less  heat  or 
moisture  ;  upon  the  surface  of  the  earth  being  com- 
pletely dry,  or  completely  covered  with  water* ; 

*  In  the  Account  of  the  Yellow  Fever  of  1793,  the  differ- 
ent and  opposite  effects  of  a  dry  and  rainy  season  in  pro- 
ducing bilious  fevers  are  mentioned  from  Dr.  Dazilles.  In 
the  autumn  of  1804,  I  have  elsewhere  remarked,  after  a 
summer  in  which  there  had  fallen  an  unusual  quantity  of 
rain,  the  bilious  fevers  appeared  chiefly  on  the  high  grounds 
in  Pennsylvania,  which  were  in  a  state  of  moisture,  while 
scarcely  a  case  of  them  appeared  in  the  neighbourhood  of 


YELLOW    FE^VER    NOT    CONTAGIOUS.      251 

upon  different  currents  of  winds,  or  the  total  absence 
of  wind ;  upon  the  disproportion  of  the  tempera- 
ture of  the  air  in  the  day  and  night ;  upon  the  quan- 
tity of  dew ;  upon  the  early  or  late  appearance  of 
warm  or  cold  weather ;  and  upon  the  predisposi- 
tion of  the  body  to  disease,  derived  from  the  quality 
of  the  aliments  of  the  season.  A  similar  want  of 
uniformity  in  the  annual  operations  of  our  climate 
appears  in  the  size  and  quality  of  grain,  fruits,  and 
vegetables  of  all  kinds. 

But  the  greater  violence  and  mortality  of  our  bi- 
lious fevers,  than  in  former  years,  must  be  sought 
for  chiefly  in  an  inflammatory  or  malignant  consti- 
tution of  the  atmosphere,  the  effects  of  which  have 
been  no  less  obvious  upon  the  small- pox,  measles, 
and  the  intercurrent  fevers  of  Dr.  Sydenham,  than 
they  are  upon  the  summer  and  autumnal  disease 
that  has  been  mentioned. 

This  malignant  state  of  the  air  has  been  noticed, 
under  different  names,  by  all  the  writers  upon  epi- 
demics, from  Hippocrates  down  to  the  present  day. 
It  was  ascribed,  by  the  venerable  father  of  physic, 

marshes,  or  low  grounds,  owing  to  their  being  so  completely 
covered  with  water,  as  to  be  incapable  of  generating,  by  pu- 
trefaction, the  miasmata  which  produce  those  forms  of  dis- 
ease. 


252      YELLOW    FEVFR    NOT    CONTAGIOUS. 

to  a  "  divine  something"  in  the  atmosphere.  Dr. 
Sydenham,  whose  works  abound  with  references  to 
it,  supposes  it  to  be  derived  from  a  mineral  exhala- 
tion from  the  bowels  of  the  earth.  From  nume- 
rous other  testimonies  of  a  belief  in  the  influence  of 
the  insensible  qualities  of  the  air,  altering  the  cha- 
racter of  epidemics,  I  shall  select  the  following  : 

"  It  is  certain  (says  Dr.  Mosely)  that  diseases 
undergo  changes  and  revolutions.  Some  continue 
for  a  succession  of  years,  and  vanish  when  they 
have  exh?aisted  the  temporary,  but  secret  cause 
which  produced  them.  Others  have  appeared  and 
disappeared  suddenly  ;  and  others  have  their  peri- 
odical returns," 

The  doctor  ascribes  a  malignant  fever  among 
the  dogs  in  Jamaica  (improperly  called,  from  one 
of  its  symptoms,  hydrophobia),  to  a  change  in  the 
atmosphere,  in  the  year  1783.  It  was  said  to  have 
been  imported,  but  experience,  he  says,  proved  the 
fact  to  be  otherwise*. 

"  This  latent  malignity  in  the  atmosphere  (says 
Baron  Vansweiten)  is  known  only  by  its  effects^ 
and  cannot  easily  be  reduced  to  any  known  species 

*  Treatise  upon  Tropical  Diseases,  p.  43,  44. 


YELX0W    FEVER    NOT    CONTAGIOUS.      253 

of  acrimony."  In  another  place  he  says,  "  It 
seems  certain  that  this  unknown  matter  disposes  all 
the  humours  to  a  sudden  and  bad  putrefaction*." 

Dr.  John  Stedman  has  related  many  facts,  in  his 
Essay  upon  Insalutary  Constitutions  of  the  Air, 
which  prove,  that  diseases  are  influenced  by  a  qua- 
lity in  it,  which,  he  says,  "  is  productive  of  cor- 
ruption," but  which  has  hitherto  eluded  the  re- 
searches of  physiciansf . 

Mr.  Lempriere,  after  mentioning  the  unusual 
mortality  occasioned  by  the  yellow  fever,  within 
the  last  five  or  six  years,  in  the  island  of  Jamaica, 
ascribes  it  wholly  "  to  that  particular  constitution 
of  atmosphere  upon  which  the  existence  of  epide- 
mics, at  one  period  rather  than  another,  depend;):." 

Not  only  diseases  bear  testimony  to  a  change  in 
the  atmosphere,  but  the  whole  vegetable  and  ani- 
mal creation  concur  in.  it,  proofs  of  which  were 
mentioned  in  another  place.     Three  things  are  re- 

*    Commentaries  on  Boerhaave's  Aphorisms,  vol.  v.  p. 

226,  230. 


f  Page  135. 
£  Vol.  ii.  p,  31. 


254      YELLOW    FEVER    NOT    CONTAGIOUS. 

markable  with  respect  to  this  inflammatory  consti- 
tution of  the  air. 


1 .  It  is  sometimes  of  a  local  nature,  and  influences 
the  diseases  of  a  city,  or  country,  while  adjoining 
cities  and  countries  are  exempted  from  it. 

2.  It  much  oftener  pervades  a  great  extent  of 
country.  This  was  evident  in  the  years  1793  and 
1794,  in  the  United  States.  During  the  same 
years,  the  yellow  fever  prevailed  in  most  of  the 
West- India  islands.  Many  of  the  epidemics  men- 
tioned by  Dr.  Sims,  in  the  first  volume  of  the  Me- 
dical Memoirs,  affected,  in  the  same  years,  the 
most  remote  parts  of  the  continent  of  Europe. 
Even  the  ocean  partakes  of  a  morbid  constitution 
of  its  atmosphere,  and  diseases  at  sea  sympathise 
in  violence  with  those  of  the  land,  at  an  immense 
distance  from  each  other.  This  appears  in  a  letter 
from  a  surgeon,  on  board  a  British  ship  of  war,  to 
Mr.  Gooch,  published  in  the  third  volume  of  his 
Medical  and  Surgical  Observations. 

3.  The  predisposing  state  of  the  atmosphere  to 
induce  malignant  diseases  continues  for  several 
years,  under  all  the  circumstances  of  wet  and  dry, 
and  of  hot  and  cold  weather.  This  will  appear, 
from  attending:  to  the  accounts  which  have  been 


YELLOW    FEVER    NOT    CONTAGIOU§.      255 

given  of  the  weather,  in  all  the  years  in  which  the 
yellow  fever*  has  prevailed  in  Philadelphia  since 
1792*.  The  remark  is  confirmed  by  all  the  records 
of  malignant  epidemics. 

It  is  to  no  purpose  to  say,  the  presence  of  the 
peculiar  matter  which  constitutes  an  inflammatory 
or  malignant  state  of  the  air  has  not  been  detected 
by  any  chemical  agents.  The  same  thing  has  been 
justly  said  of  the  exhalations  which  produce  the 
bilious  intermitting,  remitting,  and  yellow  fever. 
No  experiment  that  has  yet  been  made,  has  disco- 
vered their  presence  in  the  air.  The  eudiometer 
has  been  used  in  vain  for  this  purpose.  In  one 
experiment  made  by  Dr.  Gattani,  the  air  from  a 
marsh  at  the  mouth  of  the  river  Vateline  was  found 
to  be  apparently  purer  by  two  degrees  than  the  air 
on  a  neighbouring  mountain,  which  was  2880  feet 
higher  than  the  sea.  The  inhabitants  of  the  moun- 
tain were  notwithstanding  healthy,  while  those  who 
lived  in  the  neighbourhood  of  the  marsh  were  an- 
nually afflicted  with  bilious  and  intermitting  feversf . 
The  contagions  of  the  small-pox  and  measles  con- 
sist of  matter,  and  yet  who  has  ever  discovered 
this  matter  in  the  air  ?     We  infer  the  existence  of 

*  Vol.  iii.  and  iv. 

f  Alibert's  Dissertation  sur  les  Fievres  Pernicieuses  et 
Attaxiques  Intermittentes,  p.  185. 


256      YELLOW    FEVER    NOT    CONTAGIOUS. 

those  remote  causes  of  diseases  in  the  atmosphere 
only  from  their  effects.  Of  the  existence  of  putrid 
exhalations  in  it,  there  are  other  evidences  besides 
bilious  and  yellow  fevers.  They  are  sometimes 
the  objects  of  the  sense  of  smelling.  We  see  them 
in  the  pale  or  sallow  complexions  of  the  inhabitants 
of  the  countries  which  generate  them,  and  we  ob- 
serve them  occasionally  in  the  diseases  of  several 
domestic  animals.  The  most  frequent  of  these  dis- 
eases are  inflammation,  tubercles,  and  ulcers  in 
the  liver.  Dr.  Cleghorn  describes  a  diseased  state 
of  that  viscus  in  cattle,  in  an  unhealthy  part  of  the 
island  of  Minorca.  Dr.  Grainger  takes  notice  of 
several  morbid  appearances  in  the  livers  of  domes- 
tic animals  in  Holland,  in  the  year  1743.  But  the 
United  States  have  furnished  facts  to  illustrate  the 
truth  of  this  remark.  Mr.  James  Wardrobe,  near 
Richmond,  in  Virginia,  informed  me,  that  in  Au- 
gust, 1794,  at  a  time  when  bilious  fevers  were 
prevalent  in  his  neighbourhood,  his  cattle  were 
seized  with  a  disease,  which,  I  said  formerly,  is 
known  by  the  name  of  the  yellow  water,  and 
which  appears  to  be  a  true  yellow  fever.  They 
were  attacked  with  a  staggering.  Their  eyes  were 
muddy,  or  ferocious.  A  costiveness  attended  in 
all  cases.  It  killed  in  two  days.  Fifty-two  of  his 
cattle  perished  by  it.  Upon  opening  the  bodies  of 
several  of  them,  he  found  the  liver  swelled  and  ul- 


YELLOW    FEVER    NOT    CONTAGIOUS.      257 

cerated.  The  blood  was  dissolved  in  the  veins. 
In  the  bladder  of  one  of  them,  he  found  thirteen 
pints  of  blood  and  water.  Similar  appearances 
were  observed  in  the  livers  of  sheep  in  the  neigh- 
bourhood of  Cadiz,  in  the  year  1799,  during  the 
prevalence  of  the  yellow  fever  in  that  city.  They 
were  considered  as  such  unequivocal  marks  of  an 
unwholesome  atmosphere  among  the  ancients,  that 
they  examined  the  livers  of  domestic  animals,  in 
order  to  determine  on  the  healthy  or  unhealthy  si- 
tuation of  the  spot  on  which  they  wished  to  live. 

The  advocates  for  the  yellow  fever  being  a  spe- 
cific disease,  and  propagated  only  by  contagion, 
will  gain  nothing  by  denying  an  inflammatory  con- 
stitution of  the  atmosphere  (the  cause  of  which  is 
unknown  to  us)  to  be  necessary  to  raise  common 
remittents  to  that  grade  in  which  they  become  ma- 
lignant yellow  fevers ;  for  they  are  obliged  to  have 
recourse  to  an  unknown  quality  in  the  a;r,  every 
time  they  are  called  upon  to  account  for  the  dis- 
ease prevailing  chiefly  in  our  cities,  and  not  spread- 
ing when  it  is  carried  from  them  into  the  country. 
The  same  reference  to  an  occult  quality  in  the  air 
is  had  by  all  the  writers  upon  the  plague,  in  ac- 
counting for  its  immediate  and  total  extinction, 
when  it  is  carried  into  a  foreign  port. 

vol.    IV.  2  K 


258      YELLOW    FEVER    NOT    CONTAGIOUS. 

In  speaking  of  the  influence  of  an  inflammatory- 
constitution  of  the  atmosphere  in  raising  common 
bilious,  to  malignant  yellow  fevers,  I  wish  not  to 
have  it  supposed,  that  its  concurrence  is  necessary 
to  produce  sporadic  cases  of  that,  or  any  other 
malignant  disease.  Strong  exciting  causes,  com- 
bined with  highly  volatilized  and  active  miasmata, 
I  believe,  will  produce  a  yellow  fever  at  any- 
time. I  have  seen  one  or  more  such  cases 
almost  every  year  since  I  settled  in  Philadelphia, 
and  particularly  when  my  business  was  confined 
chiefly  to  that  class  of  people  who  live  near  the 
wharves,  and  in  the  suburbs,  and  who  are  still  the 
first,  and  frequently  the  only  victims  of  the  yellow 
fever. 

It  has  been  said,  exultingly,  that  the  opinion  of 
the  importation  of  the  yellow  fever  is  of  great  anti- 
quity in  our  country,  and  that  it  has  lately  been  ad- 
mitted by  the  most  respectable  physicians  in  Britain 
and  France,  and  sanctioned  by  the  laws  of  several  of 
the  governments  in  Europe.  Had  antiquity,  num- 
bers, rank,  and  power  been  just  arguments  in  fa- 
vour of  existing  opinions,  a  thousand  truths  would 
have  perished  in  their  birth,  which  have  diffused 
light  and  happiness  over  every  part  of  our  globe. 
In  favour  of  the  ancient  and  general  belief  of  the  im- 
portation of  the  yellow  fever,  there  are  several  obvi- 


YELLOW    FEVER    NOT    CONTAGIOUS.      259 

ous  reasons.  The  idea  is  produced  by  a  single  act  of 
the  mind.  It  requires  neither  comparison  nor  reason- 
ing to  adopt  it,  and  therefore  accords  with  the  natu- 
ral indolence  of  man.   It,  moreover,  flatters  his  ava- 
rice and  pride,  by  throwing  the  origin  of  a  mortal  dis- 
ease from  his  property  and  country.     The  principle 
of  thus  referring  the  origin  of  the  evils  of  life  from 
ourselves  to  others  is  universal.     It  began  in  para- 
dise, and  has  ever  since  been  an  essential  feature 
in  the  character  of  our  species.     It  has  constantly 
led  individuals  and  nations  to  consider  loathsome 
and  dangerous  diseases  as  of  foreign  extraction. 
The  venereal  disease  and  the  leprosy  have  no  na- 
tive country,  if  we  believe  all  the  authors  who  have 
written  upon  them.     Prosper  Alpinus  derives  the 
plagues  of  Cairo  from  Syria,  and  the  physicians  of 
of  Alexandria  import  them  from  Smyrna  or  Con- 
stantinople.    The  yellow  fever  is  said  to  have  been 
first  brought  from  Siam  (where  there  are  proofs'  it 
never  existed)  to  the  West- Indies,  whence  it  is  be- 
lieved to  be  imported  into  the  cities  of  the  United 
States.    From  them,  Frenchmen  and  Spaniards  say 
it  has  been  re- shipped,  directly  or  indirectly,  to  St. 
Domingo,   Havanna,    Malaga,    Cadiz,    and   other 
parts  of  the  world.     Weak  and  absurd  credulity  ! 
the   causes  of  the  ferocious   and   mortal  disease 
which  we  thus  thrust  from  our  respective  ports, 


260      YELLOW    FEVER    NOT    CONTAGIOUS. 

like  the  sin  of  Cain,  u  lie  exclusively  at  our  own 
doors." 

Lastly,  it  has  been  asserted,  if  we  admit  the  yel- 
low fever  to  be  an  indigenous  disease  of  our  cities, 
we  shall  destroy  their  commerce,  and  the  value  of 
property  in  them,  by  disseminating  a  belief,  that 
the  cause  of  our  disease  is  fixed  in  our  climate, 
and  that  it  is  out  of  the  power  of  human  means  to 
remove  it.  The  reverse  of  this  supposition  is 
true.  If  it  be  an  imported  disease,  our  case  is 
without  a  remedy  ;  for  if,  with  all  the  advantages 
of  quarantine  laws  enforced  by  severe  penalties, 
and  executed  in  the  most  despotic  manner,  the 
disease  has  existed  annually,  in  most  of  our  cities, 
as  an  epidemic,  or  in  sporadic  cases,  ever  since  the 
year  1791,  it  will  be  in  vain  to  expect,  from  simi- 
lar measures,  a  future  exemption  from  it.  No- 
thing but  a  belief  in  its  domestic  origin,  and  the 
adoption  of  means  founded  upon  that  belief,  can 
restore  the  character  of  our  climate,  and  save  our 
commercial  cities  from  destruction.  Those  means 
are  cheap,  practicable,  and  certain.  They  have 
succeeded,  as  I  shall  say  presently,  in  other  coun- 
tries. 

From  the  account  that  has  been  given  of  the  dif- 
ferent wavs  in  which  this  disease  is  communicated 


YELLOW    FEVER    NOT    CONTAGIOUS.      261 

from  one  person  to  another,  and  from  the  facts 
which  establish  its  propagation  exclusively  through 
the  medium  of  the  atmosphere,  when  it  becomes 
epidemic,  we  may  explain  several  things  which  be- 
long to  its  history,  that  are  inexplicable  upon  the 
principle  of  its  specific  contagion. 

1.  We  learn  the  reason  why,  in  some  instances, 
the  fever  does  not  spread  from  a  person  who  sickens 
or  dies  at  sea,  who  had  carried  the  seeds  of  it  in  his 
body  from  a  sickly  shore.  It  is  because  no  febrile 
miasmata  exist  in  the  bodies  of  the  rest  of  the  crew 
to  be  excited  into  action  by  any  peculiar  smell  from 
the  disease,  or  by  fear  or  fatigue,  and  because  no 
morbid  excretions  are  generated  by  the  person  who 
dies.  The  fever  which  prevailed  on  board  the 
Nottingham  East-Indiaman,  in  the  year  1766,  af- 
fected those  forty  men  only,  who  had  slept  on  shore 
on  the  island  of  Joanna  twenty  days  before.  Had 
the  whole  crew  been  on  shore,  the  disease  would 
probably  have  affected  them  all,  and  been  ascribed  to 
contagion  generated  by  the  first  persons  who  were 
confined  by  it*.     A  Danish  ship,  in  the  year  1768, 

*  Observations  on  the  Bilious  Fevers  usual  in  voyages  to 
the  East-Indies,  by  James  Badinach,  M.  D.  Medical  Obser- 
vations and  Inquiries,  vol.  iv. 


262      YELLOW    FEVER    NOT    CONTAGIOUS. 

sent  twelve  of  her  crew  on  shore  for  water.  They 
were  all  seized  after  their  return  to  the  ship  with  a 
malignant  fever,  and  died  without  infecting  any 
person  on  board,  and  from  the  same  causes  which 
preserved  the  crew  of  the  Nottingham  Indiaman*. 

2.  We  learn  the  reason  why  the  disease  some- 
times spreads  through  a  whole  ship's  crew,  appa- 
rently from  one  or  more  affected  persons.  It  is 
either  because  they  have  been  confined  to  small 
and  close  births  by  bad  weather,  or  because  the 
fever  has  been  protracted  to  a  typhus  or  chronic 
state,  or  because  the  bodies  of  the  whole  crew  are 
impregnated  with  morbid  miasmata,  and  thus  pre- 
disposed to  have  the  disease  excited  in  the  manner 
that  has  been  mentioned.  In  the  last  way  it  was 
excited  in  most  of  the  crew  of  the  United  States 
frigate,  in  the  Delaware,  opposite  to  the  city  of 
Philadelphia,  in  the  year  1797.  It  appears  to  have 
spread,  from  a  similar  cause,  from  a  few  sailors,  on 
board  the  Grenville  Indiaman,  after  touching  at  Ba- 
tavia.  The  whole  crew  had  been  predisposed  to 
the  disease  by  inhaling  the  noxious  air  of  that 
island. 

f  Clarke  on  the  Diseasesof  Long  Voyages  to  Hot  Climates, 
p.  123,  125. 


YELLOW    FEVER    NOT    CONTAGIOUS.      263 

The  same  reasons  account  for  the  fever  expiring 
in  a  healthy  village  or  country  ;  also  for  its  spread- 
ing when  carried  to  those  towns  which  are  seated 
upon  creeks  or  rivers,  and  in  the  neighbourhood  of 
marsh  exhalations.  It  has  uniformly  perished  in 
the  high  and  healthy  village  of  Germantown,  when 
carried  from  Philadelphia,  and  has  three  times  ap- 
peared to  be  contagious  near  the  muddy  shores  of 
the  creeks  which  flow  through  Wilmington  and 
Chester. 

3.  From  the  facts  that  have  been  mentioned, 
we  are  taught  to  disbelieve  the  possibility  of  the 
dise  ise  being  imported  in  the  masts  and  sails  of  a 
ship,  by  a  contagious  matter  secreted  by  a  sailor 
who  may  have  sickened  or  died  on  board  her,  on  a 
passage  from  a  West- India  island.  The  death  in 
most  of  the  cases  supposed  to  be  imported,  in  this 
way,  occurs  within  a  few  days  after  the  ship  leaves 
her  West- India  port,  or  within  a  few  days  after  her 
arrival.  In  the  former  case,  the  disease  is  derived 
from  West- India  miasmata ;  in  the  latter,  it  is  de- 
rived, as  was  before  remarked,  either  from  the  foul 
air  of  the  hold  of  the  ship,  or  of  the  dock  or 
wharf  to  which  the  ship  is  moored. 

Many  other  facts  might  be  adduced  to  show  the 
yellow  fever  not  to  be  an  imported  disease.     It  has 


264      YELLOW    FEVER    NOT    CONTAGIOUS. 

often  prevailed  among  the  Indians  remote  from  the 
sea  coast,  and  many  hundred  cases  of  it  have  oc- 
curred, since  the  year  1793,  on  the  inland  waters 
of  the  United  States,  from  the  Hudson  and  Sus- 
quehanna, to  the  rivers  of  the  Mississippi.  In 
South-America,  Baron  Humboldt  assured  me,  it 
is  every  where  believed  to  be  an  endemic  of  that 
country. 

These  simple  and  connected  facts,  in  which  all 
the  physicians  in  the  United  States  who  derive  the 
yellow  fever  from  domestic  causes  have  agreed,  will 
receive  fresh  support  by  comparing  them  with  the 
different  and  contrary  opinions  of  the  physicians 
who  maintain  its  importation.  Some  of  them  have 
asserted  it  to  be  a  specific  disease,  and  derived  it 
from  the  East  and  West- Indies ;  others  derive  it 
from  Beulam,  on  the  coast  of  Africa ;  a  third  sect 
have  called  it  a  ship  fever ;  a  fourth  have  ascribed 
it  to  a  mixture  of  imported  contagion  with  the  foul 
air  of  our  cities  ;  while  a  fifth,  who  believed  it  to 
be  imported  in  1793,  have  supposed  it  to  be  the  off- 
spring of  a  contagion  left  by  the  disease  of  that 
year,  revived  by  the  heat  of  our  summers,  and  dis- 
seminated, ever  since,  through  the  different  cities  of 
our  country.  The  number  of  these  opinions,  clearly 
proves,  that  no  one  of  them  is  tenable. 


YELLOW    FEVER     NOT     CONTAGIOUS.       265 

A  belief  in  the  non-contagion  of  the  yellow  fever, 
or  of  its  being  incommunicable  except  in  one  of 
the  five  ways  that  have  been  mentioned,  is  calcu- 
lated to  produce  the  following  good  effects  : 

1.  It  will  deliver  the  states  which  have  sea-ports 
from  four-fifths  of  the  expences  of  their  present 
quarantine  laws  and  lazarettoes.  A  very  small  ap- 
paratus, in  laws  and  officers,  would  be  sufficient  to 
prevent  the  landing  of  persons  affected  by  the  ship 
fever  in  our  cities,  and  the  more  dangerous  prac- 
tice, of  ships  pouring  streams  of  pestilential  air,  from 
their  holds,  upon  the  citizens  who  live  near  our 
docks  and  wharves. 

2.  It  will  deliver  our  merchants  from  the  losses 
incurred  by  the  delays  of  their  ships,  by  long  and 
unnecessary  quarantines.  It  will,  moreover,  tend 
to  procure  the  immediate  admission  of  our  ships 
into  foreign  ports,  by  removing  that  belief  in  the 
contagious  nature  of  the  yellow  fever,  which  origi- 
nated in  our  country,  and  which  has  been  spread, 
by  the  public  acts  of  our  legislatures  and  boards  of 
health,  throughout  the  globe. 

3.  It  will  deliver  our  citizens  from  the  danger 
to  which  they  are  exposed,  by  spending  the  time 
of  the  quarantine,  on  board  of  vessels  in  the  neigh- 

VOL.   iv.  2   x» 


266      YELLOW    FEVER    NOT    CONTAGIOUS. 

bourhood  of  the  marshes,  which  form  the  shores 
of  the  rivers  or  coasts  of  quarantine  roads.  This 
danger  is  much  increased  by  idleness,  and  by  the 
vexation  which  is  excited,  by  sailors  and  passen- 
gers being  detained,  unnecessarily,  fifteen  or  twen- 
ty days  from  their  business  and  friends. 

4.  It  will  lead  us  to  a  speedy  removal  of  all  the 
excretions,  and  a  constant  ventilation  of  the  rooms 
of  patients  in  the  yellow  fever,  and  thereby  to  pre- 
vent the  accumulation,  and  further  putrefaction  of 
those  exhalations  which  may  reproduce  it. 

5.  It  is  calculated  to  prevent  the  desertion  of 
patients  in  the  yellow  fever,  by  their  friends  and  fa- 
milies, and  to  produce  caution  in  them  to  prevent 
the  excitement  of  the  disease  in  their  own  bodies, 
by  means  of  low  diet  and  gentle  physic,  propor- 
tioned to  the  impurity  of  the  air,  and  to  the  anxiety 
and  fatigue  to  which  they  are  exposed  in  attending 
the  sick. 

6.  It  will  put  an  end  to  the  cruel  practice  of 
quieting  the  groundless  fears  of  a  whole  neigh- 
bourhood, by  removing  the  poor  who  are  affected 
by  the  fever,  from  their  houses,  and  conveying  them, 
half  dead  with  disease  and  terror,-  to  a  solitary  or 
crowded  hospital,  or  of  nailing  a  yellow  flag  upon 


YELLOW    FEVER    NOT    CONTAGIOUS.       267 

the  doors  of  others,  or  of  fixing  a  guard  before 
them,  both  of  which  have  been  practised  in  Phila- 
delphia, not  only  without  any  good  effect,  but  to 
the  great  injury  of  the  sick. 

7.  By  deriving  the  fever  from  our  own  climate 
and  atmosphere,  we  shall  be  able  to  foresee  its  ap- 
proach in  the  increased  violence  of  common  dis- 
eases, in  the  morbid  state  of  vegetation,  in  the 
course  of  the  winds,  in  the  diseases  of  certain  brute 
animals,  and  in  the  increase  of  common,  or  the  ap- 
pearance of  uncommon  insects. 

8.  A  belief  in  the  non- contagion  of  the  yellow 
fever,  and  its  general  prevalence  from  putrid  ani- 
mal and  vegetable  matters  only,  is  calculated  to  lead 
us  to  drain  or  cover  marshy  grounds,  and  to  re- 
move from  our  cities  all  the  sources  of  impure  air, 
whether  they  exist  in  the  holds  of  ships,  in  docks, 
gutters,  and  common  sewers,  or  in  privies,  gar- 
dens, yards,  and  cellars,  more  especially  during  the 
existence  of  the  signs  of  a  malignant  constitution 
of  the  air.  A  fever,  the  same  in  its  causes,  and 
similar  to  it  in  many  of  its  symptoms,  that  is,  the 
plague,  has  been  extirpated,  by  extraordinary  de- 
grees of  cleanliness,  from  the  cities  of  Holland, 
Great-Britain,  and  several  other  parts  of  Europe. 


268      YELLOW    PEVER    NOT    CONTAGIOUS. 

The  reader  will  perceive,  from  these  facts  and 
reasonings,  that  I  have  relinquished  the  opinion 
published  in  my  account  of  the  yellow  fever  in  the 
years  1793,  1794,  and  1797,  respecting  its  conta- 
gious nature.  I  was  misled  by  Dr.  Lining,  and 
several  West- India  writers,  in  ascribing  a  much 
greater  extent  to  the  excreted  matters  in  producing 
the  disease,  than  I  have  since  discovered  to  be  cor- 
rect, and  by  Bianchi,  Lind,  Clark,  and  Cleghorn, 
in  admitting  even  the  common  bilious  fever  to  be 
contagious.  The  reader  will  perceive,  likewise, 
that  I  have  changed  my  opinion  respecting  one  of  the 
modes  in  which  the  plague  is  propagated.  I  once 
believed,  upon  the  authorities  of  travellers,  physi- 
cians, and  schools  of  medicine,  that  it  was  a  highly 
contagious  disease.  I  am  now  satisfied  this  is  not 
the  case  ;  but,  from  the  greater  number  of  people 
who  are  depressed  and  debilitated  by  poverty  and 
famine,  and  who  live  in  small  and  filthy  huts*  in 
the  cities  of  the  east,  than  in  the  cities  of  the 
United  States,  I  still  believe  it  to  be  more  fre- 
quently communicated  from  an  intercourse  with 
sick  people  by  the  morbid  excretions  of  the  bo- 
dy, than  the  yellow  fever  is  in  our  country.  For 
the  change  of  my  opinion  upon  this  subject,  I  am 

*  M.  Savary,  in  his  Travels,  says,  two  hundred  persons 
live  in  Cairo  within  a  compass  that  accommodates  but  thirty 
persons  in  Paris. 


YELLOW    FEVER    NOT    CONTAGIOUS.      269 

indebted  to  Dr.  Caldwell's  and  Mr.  Webster's 
publications  upon  pestilential  diseases,  and  to 
the  travels  of  Mariti  and  Sonnini  into  Syria  and 
Egypt.  I  reject,  of  course,  with  the  contagi- 
ous quality  of  the  plague,  the  idea  of  its  ever  being 
imported  into  any  country  so  as  to  become  epide- 
mic, by  means  of  a  knife-case,  a  piece  of  cotton, 
or  a  bale  of  silks,  with  the  same  decision  that  I  do 
all  the  improbable  and  contradictory  reports  of  an 
epidemic  yellow  fever  being  imported  in  a  sailor's 
jacket,  or  in  the  timbers  and  sails  of  a  ship  that  had 
been  washed  by  the  salt  water,  and  fanned  by  the 
pure  air  of  the  ocean,  for  several  weeks,  on  her  pas- 
sage from  the  West- Indies  to  the  United  States. 

It  gives  me  pleasure  to  find  this  unpopular  opi- 
nion of  the  non-contagion  of  the  plague  is  not  a 
new  one.  It  was  held  by  the  Faculty  of  Medicine 
in  Paris,  in  the  beginning  of  the  eighteenth  cen- 
tury, and  it  has  since  been  defended  by  Dr.  Stoll, 
of  Vienna,  Dr.  Samoilowitz,  of  Russia,  and  seve- 
ral other  eminent  physicians.  Dr.  Herberden 
has  lately  called  in  question  the  truth  of  all  the  sto- 
ries that  are  upon  record  of  the  plague  having  been 
imported  into  England  in  the  last  century,  and  the 
researches  of  Sir  Robert  Wilson  of  the  British  ar- 
my, and  of  Assellini,  and  several  other  French  phy- 


270      YELLOW    FEVER    NOT    CONTAGIOUS. 

sicians,  have  produced  the  most  satisfactory  proofs 
of  its  not  being  a  contagious  disease  in  its  native 
country.  A  discovery  more  pregnant  with  bles- 
sings to  mankind  has  seldom  been  made.  Pyramids 
of  error,  the  works  of  successive  ages  and  nations, 
must  fall  before  it,  and  rivers  of  tears  must  be  dried 
up  by  it.  It  is  impossible  fully  to  appreciate  the 
immense  benefits  which  await  this  mighty  achieve- 
ment of  our  science  upon  the  affairs  of  the  globe. 
Large  cities  shall  no  longer  be  the  hot-beds  of  dis- 
ease and  death.  Marshy  grounds,  teeming  with 
pestilential  exhalations,  shall  become  the  healthy 
abodes  of  men.  A  powerful  source  of  repulsion 
between  nations  shall  be  removed,  and  commerce 
shall  shake  off  the  fetters  which  have  been  imposed 
upon  it  by  expensive  and  vexatious  quarantines. 
A  red  or  a  yellow  eye  shall  no  longer  be  the  signal 
to  desert  a  friend  or  a  brother  to  perish  alone  in  a 
garret  or  a  barn,  nor  to  expel  the  stranger  from  our 
houses,  to  seek  an  asylum  in  a  public  hospital,  to 
avoid  dying  in  the  street.  The  number  of  dis- 
eases shall  be  lessened,  and  the  most  mortal  of 
them  shall  be  struck  out  of  the  list  of  human  evils. 
To  accelerate  these  events,  it  is  incumbent  upon 
the  physicians  of  the  United  States  to  second  the 
discoveries  of  their  European  brethren.  It  be- 
comes them  constantly  to  recollect,  that  we  are 


YELLOW    FEVER    NOT    CONTAGIOUS.      271 

the  centinels  of  the  health  and  lives  of  our  fellow- 
citizens,  and  that  there  is  a  grade  of  benevolence 
In  our  profession  much  higher  than  that  which 
arises  from  the  cure  of  diseases.  It  consists  in. 
exterminating  their  causes. 


A  DEFENCE 


OF 


BLOOD-LETTING, 


AS   A 


REMEDY  FOR  CERTAIN  DISEASES, 


VOL.    IV.  2    M 


DEFENCE  OF  BLOOD-LETTING. 


BLOOD-LETTING,  as  a  remedy  for  fe- 
vers, and  certain  other  diseases,  having  lately  been 
the  subject  of  much  discussion,  and  many  objec- 
tions having  been  made  to  it,  which  appear  to  be 
founded  in  error  and  fear,  I  have  considered  that  a 
defence  of  it,  by  removing  those  objections,  might 
render  it  more  generally  useful,  in  every  part  of 
the  United  States. 

I  shall  begin  this  subject  by  remarking,  that 
blood-letting  is  indicated,  in  fevers  of  great  morbid 
excitement, 

1.  By  the  sudden  suppression  or  diminution  of 
the  natural  discharges  by  the  pores,  bowels,  and 
kidneys,  whereby  a  plethora  is  induced  in  the  sys- 
tem. 


276  DEFENCE    OF    BLOOD-LETTING. 

2.  By  the  habits  of  the  persons  who  are  most 
subject  to  such  fevers. 

3.  By  the  theory  of  fever.  I  have  attempted  to 
prove  that  the  higher  grades  of  fever  depend  upon 
morbid  and  excessive  action  in  the  blood-vessels. 
It  is  connected,  of  course,  with  preternatural  sen- 
sibility in  their  muscular  fibres.  The  blood  is  the 
most  powerful  irritant  which  acts  upon  them.  By 
abstracting  a  part  of  it,  we  lessen  the  principal 
cause  of  the  fever.  The  effect  of  blood-letting  is 
as  immediate  and  natural  in  removing  fever,  as  the 
the  abstraction  of  a  particle  of  sand  is,  to  cure  an 
inflammation  of  the  eye,  when  it  arises  from  that 
cause. 

4.  By  the  symptoms  of  the  first  stage  of  violent 
fevers,  such  as  a  sleepiness  and  an  oppressed  pulse, 
or  by  delirium,  with  a  throbbing  pulse,  and  great 
pains  in  every  part  of  the  body. 

§.  By  the  rupture  of  the  blood-vessels,  which 
takes  place  from  the  quantity  or  impetus  of  the 
blood  in  fevers  of  great  morbid  action.  Let  no 
one  call  bleeding  a  cruel  or  unnatural  remedy.  It 
is  one  of  the  specifics  of  nature  ;  but  in  the  use  of 
it  she  seldom  affords  much  relief.  She  frequently 
pours  the  stimulating  and  oppressing  mass  of  blood 


DEFENCE     OF    BLOOD-LETTING.  277 

into  the  lungs  and  brain ;  and  when  she  finds  an 
outlet  for  it  through  the  nose,  it  is  discharged  either 
in  such  a  deficient  or  excessive  quantity,  as  to  be 
useless  or  hurtful.  By  artificial  blood-letting,  we 
can  chuse  the  time  and  place  of  drawing  blood,  and 
we  may  regulate  its  quantity  by  the  degrees  of  ac- 
tion in  the  blood-vessels.  The  disposition  of  na- 
ture to  cure  violent  morbid  action  by  depletion,  is 
further  manifested  by  her  substituting,  in  the  room 
of  blood-letting,  large,  but  less  safe  and  less  bene- 
ficial, evacuations  from  the  stomach  and  bowels. 

6.  By  the  relief  which  is  obtained  in  fevers  of 
violent  action  by  remedies  of  less  efficacy  (to  be 
mentioned  hereafter),  which  act  indirectly  in  re- 
ducing the  force  of  the  sanguiferous  system. 

7.  By  the  immense  advantages  which  have  at- 
tended the  use  of  blood-letting  in  violent  fevers, 
when  used  at  a  proper  time,  and  in  a  quantity  suit- 
ed to  the  force  of  the  disease.  I  shall  briefly  enu- 
merate these  advantages. 

1.  It  frequently  strangles  a  fever,  when  used  in 
its  forming  state,  and  thereby  saves  much  pain, 
time,  and  expence  to  a  patient. 


278  DEFENCE    OF    BLOOD-LETTING. 

2.  It  imparts  strength  to  the  body,  by  removing 
the  depression  which  is  induced  by  the  remote 
cause  of  the  fever.  It  moreover  obviates  a  dispo- 
sition to  faint,  which  arises  from  this  state  of  the 
system. 

3.  It  reduces  the  uncommon  frequency  of  the 
pulse.  The  loss  of  ten  ounces  of  blood  reduced 
Miss  Sally  Eyre's  pulse  from  176  strokes  to  140, 
in  a  few  minutes,  in  the  fever  of  the  year  1794. 
Dr.  Gordon  mentions  many  similar  instances  of 
its  reducing  the  frequency  of  the  pulse,  in  the  puer- 
perile  fever. 

4.  It  renders  the  pulse  more  frequent  when  it  is 
preternaturally  slow. 

5.  It  checks  the  nausea  and  vomiting,  which  at- 
tend the  malignant  state  of  fever.  Of  this  I  saw 
many  instances  in  the  year  1794.  Dr.  Poissonnier 
Desperrieres  confirms  this  remark,  in  his  Account 
of  the  Fevers  of  St.  Domingo ;  and  adds  further, 
that  it  prevents,  when  sufficiently  copious,  the 
troublesome  vomiting  which  often  occurs  on  the 
fifth  day  of  the  yellow  fever*.  It  has  the  same  ef- 
fect in  preventing  the  diarrhoea  in  the  measles. 

*  Traite  des  Fievres  de  l'lsle  de  St.  Domingue,  vol.  ii. 
p.  75. 


DEFENCE    OF    BLOOD-LETTING.  279 

6.  It  renders  the  bowels,  when  costive,  more 
easily  moved  by  purging  physic. 

7.  It  renders  the  action  of  mercury  more  speedy 
and  more  certain,  in  exciting  a  salivation. 

8.  It  disposes  the  body  to  sweat  spontaneously, 
or  renders  diluting  and  diaphoretic  medicines  more 
effectual  for  that  purpose. 

9.  It  suddenly  removes  a  dryness,  and  gradually 
a  blackness,  from  the  tongue.  Of  the  former  ef- 
fect of  bleeding,  I  saw  two  instances,  and  of  the  lat- 
ter, one,  during  the  autumn  of  1794. 

10.  It  removes  or  lessens  pain  in  every  part  of 
the  body,  and  more  especially  in  the  head. 

* 

11.  It  removes  or  lessens  the  burning  heat  of 
the  skin,  and  the  burning  heat  in  the  stomach,  so 
common  and  so  distressing  in  the  yellow  fever. 

12.  It  removes  a  constant  chilliness,  which 
sometimes  continues  for  several  days,  and  which 
will  neither  yield  to  cordial  drinks,  nor  warm  bed- 
clothes. 


280  DEFENCE    OF    BLOOD-LETTING. 

13.  It  checks  such  sweats  as  are  profuse  with- 
out affording  relief,  and  renders  such  as  are  partial 
and  moderate,  universal  and  salutary. 

14.  It  sometimes  checks  a  diarrhoea  and  tenes- 
mus, after  astringent  medicines  have  been  given  to 
no  purpose.  This  has  often  been  observed  in  the 
measles. 

15.  It  suddenly  cures  the  intolerance  of  light 
which  accompanies  many  of  the  inflammatory  states 
of  fever. 

16.  It  removes  coma.  Mr.  Henry  Clymer 
was  suddenly  relieved  of  this  alarming  symptom, 
in  the  fever  of  1794,  by  the  loss  of  twelve  ounces 
of  blood. 

17.  It  induces  sleep.  This  effect  of  bleeding  is 
so  uniform,  that  it  obtained,  in  the  year  1794,  the 
name  of  an  anodyne  in  several  families.  Sleep 
sometimes  stole  upon  the  patient  while  the  blood 
was  flowing. 

18.  It  prevents  effusions  of  serum  and  blood. 
Haemorrhages  seldom  occur,  where  bleeding  has 
been  sufficiently  copious. 


DEFENCE    OF    BLOOD-LETTING.  281 

19.  It  belongs  to  this  remedy  to  prevent  the 
chronic  diseases  of  cough,  consumption,  jaundice, 
abscess  in  the  liver,  and  all  the  different  states  of 
dropsy  which  so  often  follow  autumnal  fevers. 

My  amiable  friend,  Mrs.  Lenox,  furnished  an  ex- 
ception to  this  remark,  in  the  year  1794.     After 
having  been  cured  of  the  yellow  fever  by  seven 
bleedings,  she  was  affected,  in  consequence  of  tak- 
ing a  ride,  with  a  slight  return  of  fever,  accompanied 
by  an  acute  pain  in  the  head,  and  some  of  the 
symptoms  of  a  dropsy  of  the  brain.     As  her  pulse 
was  tense  and  quick,  I  advised  repeated  bleedings 
to  remove  it.    This  prescription,  for  reasons  which 
it  is  unnecessary  to  relate,  was  not  followed  at  the 
time,  or  in  the  manner,  in  which  it  was  recom- 
mended.    The  pain,  in  the  mean  time,  became 
more  alarming.     In  this  situation,  two  physicians 
were  proposed  by  her  friends  to  consult  with  me. 
I  objected  to  them  both,  because  I  knew  their  prin- 
ciples and  modes  of  practice  to  be  contrary  to  mine, 
and  that  they  were  proposed  only  with  a  view  of 
wresting  the  lancet  from  my  hand.     From  this  de- 
sire of  avoiding  a  controversy  with  my  brethren, 
where  conviction  was  impossible  on  either  side,  as 
well  as  to  obviate  all  cause  of  complaint  by  my  pa- 
tient's friends,  I  offered  to  take  my  leave  of  her, 
and  to  resign  her  wholly  to  the  care  of  the  two  gen- 

VOL.    TV.  2  N 


282  DEPENCE    OF    BLOOD-LETTING. 

tlemen  who  were  proposed  to  attend  her  with  me. 
To  this  she  objected  in  a  decided  manner.  But 
that  I  might  not  be  suspected  of  an  undue  reliance 
upon  my  own  judgment,  I  proposed  to  call  upon 
Dr.  Griffitts  or  Dr.  Physick  to  assist  me  in  my  at- 
tendance upon  her.  Both  these  physicians  had  re- 
nounced the  prejudices  of  the  schools  in  which 
they  had  been  educated,  and  had  conformed  their 
principles  and  practice  to  the  present  improving 
state  of  medical  science.  My  patient  preferred  Dr. 
Griffitts,  who,  in  his  first  visit  to  her,  as  soon  as 
he  felt  her  pulse,  proposed  more  bleeding.  The 
operation  was  performed  by  the  doctor  himself,  and 
repeated  daily  for  five  days  afterwards.  From  an 
apprehension  that  the  disease  was  so  fixed  as  to  re- 
quire some  aid  to  blood-letting,  we  gave  her  calo- 
mel in  such  large  doses  as  to  excite  a  salivation. 
By  the  use  of  these  remedies  she  recovered  slowly, 
but  so  perfectly  as  to  enjoy  her  usual  health. 

20.  Bleeding  prevents  the  termination  of  malig- 
nant, in  the  gangrenous  state  of  fever.  This  effect 
of  blood-letting  will  enable  us  to  understand  some 
things  in  the  writings  of  Dr.  Morton  and  Dr.  Sy- 
denham, which  at  first  sight  appear  to  be  unintel- 
ligible. Dr.  Morton  describes  what  he  calls  a  pu- 
trid fever,  which  was  epidemic  and  fatal,  in  the 
year  1678.     Dr.  Sydenham,  who  practised  in  Lon- 


DEFENCE    OF    BLOOD-LETTING.  283 

don  at  the  same  time,  takes  no  notice  of  this  fever. 
The  reason  of  his  silence  is  obvious.  By  copious 
bleeding,  he  prevented  the  fever  of  that  year  from 
running  on  to  the  gangrenous  state,  while  Dr. 
Morton,  by  neglecting  to  bleed,  created  the  sup- 
posed putrid  fevers  which  he  has  described. 

It  has  been  common  to  charge  the  friends  of 
blood-letting  with  temerity  in  their  practice.  From 
this  view  which  has  been  given  of  it,  it  appears, 
that  it  would  be  more  proper  to  ascribe  timidity 
to  them,  for  they  bleed  to  prevent  the  offensive  and 
distressing  consequences  of  neglecting  it,  which 
have  been  mentioned. 


2: 


11.  It  cures,  without  permitting  a  fever  to  put 
on  those  alarming  symptoms,  which  excite  con- 
stant apprehensions  of  danger  and  death,  in  the 
minds  of  patients  and  their  friends.  It  is  because 
these  alarming  symptoms  are  prevented,  by  bleed- 
ing, that  patients  are  sometimes  unwilling  to  believe 
they  have  been  cured  by  it,  of  a  malignant  fever. 
Thus,  the  Syrian  leper  of  old,  viewed  the  water  of 
Jordan  as  too  simple  and  too  common  to  cure  a 
formidable  disease,  without  recollecting  that  the  re- 
medies for  the  greatest  evils  of  life  are  all  simple, 
and  within  the  power  of  the  greatest  part  of  man- 
kind. 


284  DEFENCE    OF    BLOOD-LETTING. 

22.  It  prepares  the  way  for  the  successful  use  of 
the  bark  and  other  tonic  remedies,  by  destroying, 
or  so  far  weakening,  a  morbid  action  in  the  blood- 
vessels, that  a  medicine  of  a  moderate  stimulus  af- 
terwards exceeds  it  in  force,  and  thereby  restores 
equable  and  healthy  action  to  the  system. 

23.  Bleeding  prevents  relapses.  It,  moreover, 
prevents  that  predisposition  to  the  intermitting  and 
pleuritic  states  of  fever,  which  so  frequently  attack 
persons  in  the  spring,  who  have  had  the  biliousTe- 
mitting  fever  in  the  preceding  autumn. 

But  great  and  numerous  as  the  advantages  of 
blood-letting  are  in  fevers,  there  have  been  many 
objections  to  it.  I  shall  briefly  enumerate,  and  en- 
deavour to  refute  the  errors  upon  this  subject. 

Blood-letting  has  been  forbidden  by  physicians, 
by  the  following  circumstances,  and  states  of  the 
system. 

1.  By  warm  weather.  Galen  bled  in  a  plague, 
and  Arasteus  in  a  bilious  fevei\  in  a  warm  climate. 
Dr.  Sydenham  and  Dr.  Hillary  inform  us,  that 
the  most  inflammatory  fevers  occur  in,  and  suc- 
ceed hot  weather.  Dr.  Cleghorn  prescribed  it 
copiously  in  the  warm  months,  in  Minorca.     Dr. 


DEFENCE    OF    BLOOD-LETTING.  285 

Mosely  cured  the  yellow  fever  by  this  remedy,  in 
Jamaica.  Dr.  Broadbelt,  and  Dr.  Weston,  in  the 
same  island,  have  lately  adopted  his  successful  prac- 
tice. Dr.  Desportes  speaks  in  the  highest  terms 
of  it  in  all  the  inflammatory  diseases  of  St.  Domin- 
go. He  complains  of  the  neglect  of  it  in  the  rheu- 
matism, in  consequence  of  which,  he  says,  the  dis- 
ease produces  abscesses  in  the  lungs*.  I  have  ne- 
ver, in  any  year  of  my  practice,  been  restrained 
by  the  heat  of  summer  in  the  use  of  the  lancet, 
where  the  pulse  has  indicated  it  to  be  necessary, 
and  have  always  found  the  same  advantages  from 
it,  as  when  I  have  prescribed  it  in  the  winter  or 
spring  months. 

In  thus  deciding  in  favour  of  bleeding  in  warm 
weather,  I  do  not  mean  to  defend  its  use  to  the 
same  extent,  as  to  diseases,  or  to  quantity,  in  the 
native  and  long  settled  inhabitants  of  hot  climates, 
as  in  persons  who  have  recently  migrated  to  them, 
or  who  live  in  climates  alternately  hot  and  cold. 

2.  Being  born,  and  having  lived  in  a  warm  cli- 
mate. This  is  so  far  from  being  an  objection  to 
blood-letting  in  an  inflammatory  disease,  that  it  ren- 
ders it  more  necessary.     I  think  I  have  lost  seve- 


Page 


JO. 


286  DEFENCE    OF    BLOOD-LETTING. 

ral  West- India  patients  from  the  influence  of  this 
error. 

3.  Great  apparent  weakness.  This,  in  acute 
and  violent  fevers,  is  always  from  a  depressed  state 
of  the  system.  It  resembles,  in  so  many  particu- 
lars, that  weakness  which  is  the  effect  of  the  ab- 
straction of  stimulus,  that  it  is  no  wonder  they  have 
been  confounded  by  physicians.  This  sameness 
of  symptoms  from  opposite  states  of  the  system  is 
taken  notice  of  by  Hippocrates.  He  describes  con- 
vulsions, and  particularly  a  hiccup,  as  occurring 
equally  from  repletion  and  inanition,  which  answer 
to  the  terms  of  depression,  and  debility  from  action 
and  abstraction.  The  natural  remedy  for  the  for- 
mer is  depletion,  and  no  mode  of  depleting  is  so 
effectual  or  safe  as  blood-letting.  But  the  great 
objection  to  this  remedy  is,  when  a  fever  of  great 
morbid  excitement  affects  persons  of  delicate  con- 
stitutions, and  such  as  have  long  been  subject  to 
debility  of  the  chronic  kind.  In  this  state  of  the 
system  there  is  the  same  morbid  and  preternatural 
action  in  the  blood-vessels,  that  there  is  in  persons 
of  robust  habits,  and  the  same  remedy  is  necessary 
to  subdue  it  in  both  cases.  It  is  sometimes  indi- 
cated in  a  larger  quantity  in  weakly  than  in  robust 
people,  by  the  plethora  which  is  more  easily  induced 
in  their  relaxed  and  yielding  blood-vessels,  and  by 


DEFENCE    OF    BLOOD-LETTING.  287 

the  greater  facility  with  which  ruptures  and  effu- 
sions take  place  in  their  viscera.  Thus  it  is  more 
necessary  to  tfirow  overboard  a  large  part  of  the 
cargo  of  an  old  and  leaky  vessel  in  a  storm,  than  of 
a  new  and  strong  one.  I  know  that  vomits,  purges, 
sweats,  and  other  evacuating  remedies,  are  prefer- 
red to  bleeding  in  weakly  constitutions,  but  I  hope 
to  show  hereafter,  that  bleeding  is  not  only  more 
effectual,  but  more  safe  in  such  habits,  than  any 
other  depleting  remedy. 

4.  Infancy  and  childhood.  This  is  so  far  from 
being  an  objection  to  bleeding,  that  the  excitable 
state  of  the  blood-vessels  in  those  periods  of  life, 
renders  it  peculiarly  necessary  in  their  inflammatory 
diseases.  Dr.  Sydenham  bled  children  in  the 
hooping  cough,  and  in  dentitione  I  have  followed 
his  practice,  and  bled  as  freely  in  the  violent  states 
of  fever  in  infancy  as  in  middle  life.  I  bled  my 
eldest  daughter  when  she  was  but  six  weeks  old, 
for  convulsions  brought  on  by  an  excessive  dose  of 
laudanum  given  to  her  by  her  nurse ;  and  I  bled 
one  of  my  sons  twice,  before  he  was  two  months 
old,  for  an  acute  fever  which  fell  upon  his  lungs 
and  bowels.  In  both  cases,  life  appeared  to  be 
saved  by  this  remedy. 


288  DEFENCE    OF    BLOOD-LETTING. 

5.  Old  age.  The  increase  of  appetite  in  old 
people,  their  inability  to  use  sufficient  exercise, 
whereby  their  blood-vessels  become  relaxed,  ple- 
thoric, and  excitable,  and  above  all,  the  translation 
of  the  strength  of  the  muscles  to  the  arteries,  and 
of  plethora  to  the  veins,  all  indicate  bleeding  to  be 
more  necessary  (in  equal  circumstances)  in  old, 
than  in  middle  aged  people.  My  practice  in  the 
diseases  of  old  people  has  long  been  regulated  by 
the  above  facts.  I  bled  Mrs.  Fullarton  twice  in  a 
pleurisy  in  January,  1804,  in  die  84th  year  of  her 
age,  and  thereby  cured  her  disease.  I  am  not  the 
author  of  this  practice.  Botallus  left  a  testimony 
in  favour  of  it  nearly  200  years  ago*,  and  it  has 
since  been  confirmed  by  the  experience  of  Hoff- 
man, and  many  other  physicians.  An  ignorance  of, 
or  inattention  to  this  change  in  the  state  of  the 
blood-vessels,  in  persons  in  the  decline  of  life,  and 
the  neglect  of  the  only  remedy  indicated  by  it,  is 
probably  the  reason  why  diseases  often  prove  fatal 
to  them,  which  in  early  or  middle  life  cured  them- 
selves, or  yielded  to  a  single  dose  of  physic,  or  a 
few  ounces  of  bark. 

*  Magis  esse  adjuvandos  series,  missione  sanguinis  dum 
morbus  postulat,  aut  corpus  eorum  habitus  malus  est,  quam 
(quod  absonum  videbitur)  juvenibus  ccntingunt. 

De  Cur.  per  Sang,  missionem,  cap.  11.  §  11. 


DEFENCE    OF    BLOOD-LETTING.  289 

6.  The  time  of  menstruation.  The  uterus,  dur- 
ing this  period,  is  in  an  inflamed  state,  and  the  whole 
system  is  plethoric  and  excitable,  and  of  course 
disposed  to  a  violent  degree  of  fever,  from  all  the 
causes  which  excite  it.  Bleeding,  therefore,  is 
more  indicated,  in  fever  of  great  morbid  action,  at 
this  time,  than  at  any  other.  Formerly  the  natural 
discharge  from  the  uterus  was  trusted  to,  to  remove 
a  fever  contracted  during  the  time  of  menstruation ; 
but  what  relief  can  the  discharge  of  four  or  five 
ounces  of  blood  from  the  uterus  afford,  in  a  fever 
which  requires  the  loss  of  50,  or  perhaps  of  100 
ounces  to  cure  it  ? 

7.  Pregnancy.  The  inflammation  and  distention 
induced  upon  the  uterus  directly,  and  indirectly 
upon  the  whole  system  by  pregnancy,  render^bleed- 
ing,  in  the  acute  states  of  fever,  more  necessary  than 
at  other  times.  I  have  elsewhere  mentioned  the 
advantages  of  bleeding  pregnant  women,  in  the  yel- 
low fever.  I  did  not  learn  the  advantages  of  the 
practice  in  that  disease.  I  bled  Mrs.  Philler  11 
times  in  seven  days,  in  a  pleurisy  during  her  preg- 
nancy, in  the  month  of  March,  1783.  Mrs.  Fiss 
was  bled  13  times  in  the  spring  of  1783  ;  and  Mrs. 
Kirby  16  times  in  the  same  condition,  by  my  or- 
ders, in  the  winter  of  1786,  in  a  similar  disease. 
All  these  women  recovered,  and  the  children  they 

vol.   iv.  2  o 


290  DEFENCE    OF    BLOOD-LETTING. 

carried  during  their  illness,  are  at  this  time  alive, 
and  in  good  health. 

8.  Fainting  after  bleeding.  This  symptom  is 
accidental  in  many  people.  No  inference  can  be 
drawn  from  it  against  blood-letting.  It  often  oc- 
curs after  the  first  and  second  bleedings  in  a  fever, 
but  in  no  subsequent  bleeding,  though  it  be  re- 
peated a  dozen  times.  Of  this  I  saw  several  in- 
stances, in  the  yellow  fever  of  1794.  The  pulse, 
during  the  fainting,  is  often  tense  and  full. 

9.  Coldness  of  the  extremities,  and  of  the  whole 
body.  This  cold  state  of  fever  when  it  occurs 
early,  yields  more  readily  to  bleeding,  than  to  the 
most  cordial  medicines. 


10.  Sweats  are  supposed  to  forbid  blood-letting. 
I  have  seen  two  instances  of  death,  from  leaving  a 
paroxysm  of  malignant  fever  to  terminate  itself  by 
sweating.  Dr.  Sydenham  has  taught  a  contrary 
practice  in  the  following  case.  "  While  this  con- 
stitution (says  the  doctor)  prevailed,  I  was  called  to 
Dr.  Morice,  who  then  practised  in  London.  He 
had  this  fever,  attended  with  profuse  sweats,  and 
numerous  petechias.  By  the  consent  of  some  other 
physicians,  our  joint  friends,  he  was  blooded,  and 
rose  from  his  bed,  his  body  being  first  wiped  dry. 


DEFENCE    OP    BLOOD-LETTING.  291 

He  Found  immediate  relief  from  the  use  of  a  cool- 
ing diet  and  medicines,  the  dangerous  symptoms 
soon  going  off;  and  by  continuing  this  method  he 
recovered  in  a  few  days*."  In  the  same  fever,  the 
doctor  adds  further,  "  For  though  one  might  ex- 
pect great  advantages  in  pursuing  an  indication 
taken  from  what  generally  proves  serviceable  (viz. 
sweating),  yet  I  have  found,  by  constant  experience, 
that  the  patient  not  only  finds  no  relief,  but,  con- 
trariwise, is  more  heated  thereby ;  so  that  fre- 
quently a  delirium,  petechia?,  and  other  very  danger- 
ous symptoms  immediately  succeed  such  sweats\." 

Morgagni  describes  a  malignant  fever  which  pre- 
vailed in  Italy,  in  which  the  patients  died  in  pro- 
fuse sweats,  while  their  physicians  were  looking  for 
a  crisis  from  them.  Bleeding  would  probably  have 
checked  these  sweats,  and  cured  the  fever. 

11.  Dissolved  blood,  and  an  absence  of  an  in- 
flammatory crust  on  its  crassamentum.  I  shall 
hereafter  place  dissolved  blood  at  the  highest  point 
of  a  scale,  which  is  intended  to  mark  the  different 
degrees  of  morbid  action  in  the  system.  I  have 
mentioned,  in  the  Outlines  of  a  Theory  of  Fe- 

*  Wallis's  edition,  vol.  i.  p.  210. 
t  Vol.  i.  p.  208. 


292  DEFENCE    OF    BLOOD-LETTING. 

ver,  that  it  is  the  effect  of  a  tendency  to  a  palsy,  in- 
duced by  the  violent  force  of  impression  upon  the 
blood-vessels.  This  appearance  of  the  blood  in 
certain  states  of  fever,  instead  of  forbidding  bleed- 
ing, is  the  most  vehement  call  of  the  system  for  it. 
Nor  is  the  absence  of  a  crust  on  the  crassamentum 
of  the  blood,  a  proof  of  the  absence  of  great  mor- 
bid diathesis,  or  a  signal  to  lay  aside  the  lancet. 
On  the  contrary,  I  shall  show  hereafter,  that  there 
are  several  appearances  of  the  blood  which  indi- 
cate more  morbid  action  in  the  blood-vessels  than 
a  sizy  or  inflammatory  crust. 

12.  An  undue  proportion  of  serum  to  crassa- 
mentum in  the  blood.  This  predominance  of  wa- 
ter in  the  blood  has  often  checked  sufficient  blood- 
letting. But  it  should  be  constantly  disregarded 
while  it  is  attended  with  those  states  of  pulse  (to  be 
mentioned  hereafter)  which  require  bleeding. 

14.  The  presence  of  petechias  on  the  skin. 
These,  I  have  elsewhere  said,  are  the  effects  of  the 
gangrenous  state  of  fever.  Dr.  S}*denham  and  Dr. 
de  Haen  have  taught  the  safety  and  advantage  of 
bleeding,  when  these  spots  are  accompanied  by  an 
active  pulse.  A  boy  of  Mr.  John  Carrol  owes 
his  recovery  from  the  small- pox  to  the  loss  of  fifty 
ounces  of  blood,  by  five  bleedings,  at  a  time  when 


DEFENCE    OF    BLOOD-LETTING.  293 

nearly  every  pock  on  his  arms  and  legs  had  a  pur- 
ple appearance.  Louis  XIV  was  bled  five  times 
in  the  small-pox,  when  he  was  but  thirteen  years  of 
age,  and  thereby  probably  saved  from  the  grave, 
to  the  great  honour  and  emolument  of  the  single 
physician  who  urged  it  against  the  advice  of  all  the 
other  physicians  of  the  court.  Dr.  Cleghorn  men- 
tions a  single  case  of  the  success  of  bleeding  in  the 
petechial  small-pox.  His  want  of  equal  success 
afterwards,  in  similar  cases,  was  probably  occasion- 
ed by  his  bleeding  too  sparingly,  that  is,  but  three 
or  four  times. 

Abscesses  and  sore  breasts,  which  accompany  or 
succeed  fever,  are  no  objections  to  blood-letting, 
provided  the  pulse  indicate  the  continuance  of  in- 
flammatory diathesis.  They  depend  frequently  up- 
on the  same  state  of  the  system  as  livid  effusions 
on  the  skin. 

14.  The  long  duration  of  fever.  Inflammatory 
diathesis  is  often  protracted  for  many  weeks,  in  the 
chronic  state  of  fever.  It,  moreover,  frequently  re- 
vives after  having  disappeared,  from  an  accidental 
irritant  affecting  some  part  of  the  body,  particularly 
the  lungs  and  brain.  I  bled  a  young  man  of  James 
Cameron,  in  the  autumn  of  1794,  four  times  be- 
tween the  20th  and  30th  days  of  a  chronic  fever, 


294  DEIENCE    OF    BLOOD-LETTIN  G. 

in  consequence  of  a  pain  in  the  side,  accompanied 
by  a  tense  pulse,  which  suddenly  came  on  after  the 
20th  day  of  his  disease.  His  blood  was  sizy.  His 
pain  and  tense  pulse  were  subdued  by  the  bleeding, 
and  he  recovered.  I  bled  the  late  Dr.  Prowl 
twelve  times,  in  a  fever  which  continued  thirty  days, 
in  the  autumn  of  the  year  1800.  I  wish  these 
cases  to  be  attended  to  by  young  practitioners. 
The  pulmonary  consumption  is  often  the  effect  of 
a  chronic  fever,  terminating  with  fresh  inflamma- 
tory symptoms,  by  effusions  in  the  lungs.  It  may 
easily  be  prevented  by  forgetting  the  number  of  the 
days  of  our  patient's  fever,  and  treating  the  pulmo- 
nary affection  as  if  it  were  a  recent  complaint. 

15.  Tremors  and  slight  convulsions  in  the  limbs. 
Bark,  wine,  laudanum,  and  musk  are  generally  pre- 
scribed to  remove  these  symptoms ;  but,  to  be  ef- 
fectual, they  should,  in  most  cases,  be  preceded  by 
the  loss  of  a  few  ounces  of  blood. 

16.  Bleeding  is  forbidden  after  the  fifth  or  se- 
venth day  in  a  pleurisy.  This  prohibition  was  in- 
troduced into  medicine  at  a  time  when  a  fear  was 
entertained  of  arresting  the  progress  of  nature  in 
preparing  and  expelling  morbific  matter  from  the 
system.  From  repeated  experience  I  can  assert, 
that  bleeding  is  safe  in  every  stage  of  pleurisy  in 


DEFENCE    OF    BLOOD-LETTING.  295 

which  there  is  pain,  and  a  tense  and  oppressed 
pulse  ;  and  that  it  has,  when  used  for  the  first  time 
after  the  fifth  and  seventh  days,  saved  many  lives. 
Bleeding  has  likewise  been  limited  to  a  certain 
number  of  ounces  in  several  states  of  fever.  Were 
the  force  of  the  remote  cause  of  a  fever,  its  degrees 
of  violence,  and  the  habits  of  the  subject  of  it,  al- 
ways the  same,  this  rule  would  be  a  proper  one ; 
but,  this  not  being  the  case,  we  must  be  governed 
wholly  by  the  condition  of  the  system,  manifested 
chiefly  by  the  state  of  the  pulse.  To  admit  of  co- 
pious bleeding  in  one  state  of  fever,  and  not  in  ano- 
ther, under  equal  circumstances  of  morbid  excite- 
ment, is  to  prescribe  for  its  name,  and  to  forget 
the  changes  which  climate,  season,  and  previous 
habits  create  in  all  its  different  states. 

17.  The  loss  of  a  sufficient  quantity  of  blood  is 
often  prevented  by  patients  being  apparently  worse, 
after  the  first  or  second  bleeding.  This  change  for 
the  worse,  shows  itself  in  some  one  or  more  of  the 
following  symptoms,  viz.  increase  of  heat,  chills, 
delirium,  haemorrhages,  convulsions,  nausea,  vomit- 
ing, faintness,  coma,  great  weakness,  pain,  a  tense, 
after  a  soft  pulse,  and  a  reduction  of  it  in  force 
and  frequency.  They  are  all  occasioned  by  the 
system  rising  suddenly  from  a  state  of  extreme  de- 
pression, in  consequence  of  the  abstraction  of  the 


296  DEFENCE    OF    BLOOD-LETTING. 

pressure  of  the  blood  to  a  state  of  vigour  and  acti- 
vity, so  great,  in  some  instances,  as  to  reproduce 
a  depression  below  what  existed  in  the  system  be- 
fore a  vein  was  opened ;  or  it  is  occasioned  by  a 
translation  of  morbid  action  from  one  part  of  the 
body  to  another. 

The  chills  which  follow  bleeding  are  the  effects 
of  a  change  in  the  fever,  from  an  uncommon  to  a 
common  state  of  malignity.  They  occur  chiefly  in 
those  violent  cases  of  fever  which  come  on  without 
a  chilly  fit. 

The  haemorrhages  produced  by  bleeding  are 
chiefly  from  the  nose,  hemorrhoidal  vessels,  or  ute- 
rus, and  of  course  are,  for  the  most  part,  safe. 

Uncommon  weakness,  succeeding  blood-letting, 
is  the  effect  of  sudden  depression  induced  upon  the 
whole  system,  by  the  cause  before- mentioned,  or 
of  a  sudden  translation  of  the  excitement  of  the 
muscles  into  the  blood-vessels,  or  some  other  part 
of  the  body.  These  symptoms,  together  with  all 
the  others  which  have  been  mentioned,  are  so  far 
from  forbidding,  that  they  all  most  forcibly  indicate 
a  repetition  of  blood-letting. 


DEFENCE    OF    BLOOD-LETTING.  297 

I  shall  briefly  illustrate,  by  the  recital  of  three 
cases,  the  good  effects  of  bleeding,  in  removing 
pain,  and  the  preternatural  slowness  and  weakness 
of  the  pulse,  when  produced  by  the  use  of  that  re- 
medy. 

In  the  month  of  June  of  1795,  I  visited  Dr.  Say 
in  a  malignant  fever,  attended  with  pleuritic  symp- 
toms, in  consultation  with  Dr.  Physick.  An  acute 
pain  in  his  head  followed  six  successive  bleedings. 
After  a  seventh  bleeding,  he  had  no  pain.  His  fe- 
ver soon  afterwards  left  him.  In  thus  persevering 
in  the  use  of  a  remedy,  which,  for  several  days, 
appeared  to  do  harm,  we  were  guided  wholly  by 
the  state  of  his  pulse,  which  uniformly  indicated, 
by  its  force,  the  necessity  of  more  bleeding. 

In  the  autumn  of  1794,  I  was  sent  for  to  visit 
Samuel  Bradford,  a  young  man  of  about  20  years 
of  age,  son  of  Mr.  Thomas  Bradford,  who  was  ill 
with  the  reigning  malignant  epidemic.  His  pulse 
was  at  80.  I  drew  about  12  ounces  of  blood  from 
him.  Immediately  after  his  arm  was  tied  up,  his 
pulse  fell  to  60  strokes  in  a  minute.  I  bled  him  a 
second  time,  but  more  plentifully  than  before,  and 
thereby,  in  a  few  minutes,  brought  his  pulse  back 
again  to  80  strokes  in  a  minute.     A  third  bleeding 

vol.   iv.  2  p 


298  DEFENCE    OF    BLOOD-LETTING. 

the  next  day,  aided  by  the  usual  purging  physic, 
cured  him  in  a  few  davs. 


In  the  month  of  March,  1795,  Dr.  Physick  re- 
quested me  to  visit,  with  him,  Mrs.  Fries,  the  wife 
of  Mr.  John  Fries,  in  a  malignant  fever.  He  had 
bled  her  four  times.  After  the  fourth  bleeding, 
her  pulse  suddenly  fell,  so  as  scarcely  to  be  percep- 
tible. I  found  her  hands  and  feet  cold,  and  her 
x  countenance  ghastly,  as  if  she  were  in  the  last  mo- 
ments of  life.  In  this  alarming  situation,  I  sug- 
gested nothing  to  Dr.  Physick  but  to  follow  his 
judgment,  for  I  knew  that  he  was  master  of  that 
law  of  the  animal  economy  which  resolved  all  her 
symptoms  into  an  oppressed  state  of  the  system. 
The  doctor  decided  in  a  moment  in  favour  of  more 
bleeding.  During  the  flowing  of  the  blood,  the 
pulse  rose.  At  the  end  of  three,  ten,  and  seven- 
teen hours  it  fell,  and  rose  again  by  three  succes- 
sive bleedings,  in  all  of  which  she  lost  about  thirty 
ounces  of  sizy  blood.  So  great  was  the  vigour 
acquired  by  the  pulse,  a  few  days  after  the  parox- 
ysms of  depression,  which  have  been  described, 
were  relieved,  that  it  required  seven  more  bleedings 
to  subdue  it.  I  wish  the  history  of  these  two  cases 
to  be  carefully  attended  to  by  the  reader.  I  have 
been  thus  minute  in  the  detail  of  them,  chiefly  be- 
cause I  have  heard  of  practitioners  who  have  lost 


DEFENCE     OE    BLOOD-LETTING.  299 

patients  by  attempting  to  raise  a  pulse  that  had 
been  depressed  by  bleeding,  in  a  malignant  fever, 
by  means  of  cordial  medicines,  instead  of  the  re- 
peated use  of  the  lancet.  The  practice  is  strictly 
rational ;  for,  in  proportion  as  the  blood-vessels  are 
weakened  by  pressure,  the  quantity  of  blood  to  be 
moved  should  be  proportioned  to  the  diminution 
of  their  strength. 

This  depressed  state  of  the  pulse,  whether  in- 
duced by  a  paroxysm  of  fever,  or  by  blood-letting, 
is  sometimes  attended  with  a  strong  pulsation  of  the 
arteries  in  the  bowels  and  head. 

I  have  mentioned,  among  the  apparent  bad  ef- 
fects of  bleeding,  that  it  sometimes  changes  a  soft 
into  a  tense  pulse.  Of  this  I  saw  a  remarkable  in- 
stance in  Captain  John  Barry,  in  the  autumn  of 
1795.  After  the  loss  of  130  ounces  of  blood  in  a 
malignant  yellow  fever,  his  pulse  became  so  soft  as 
to  indicate  no  more  bleeding.  In  this  situation  he 
remained  for  three  days,  but  without  mending  as 
rapidly  as  I  expected  from  the  state  of  his  pulse. 
On  the  fourth  day  he  had  a  haemorrhage  from  his 
bowels,  from  which  he  lost  above  a  pint  of  blood. 
His  pulse  now  suddenly  became  tense,  and  conti- 
nued so  for  two  or  three  days.  I  ascribed  this 
change  in  his  pulse  to  the  vessels  of  the  bowels, 


300  DEFENCE    OF    BLOOD-LETTING. 

which  had  been  oppressed  by  congestion,  being  so 
much  relieved  by  the  haemorrhage,  as  to  resume  an 
inflammatory  action.  I  have  observed  a  similar 
change  to  take  place  in  the  pulse,  after  a  third  bleed- 
ing, in  a  case  of  hemorrhoidal  fever,  which  came 
under  my  notice  in  the  month  of  January,  1803. 
It  is  thus  we  see  the  blood-vessels,  in  a  common 
phlegmon,  travel  back  again,  from  a  tendency  to 
mortification,  to  the  red  colour  and  pain  of  common 
inflammation. 

From  a  review  of  the  commotions  excited  in  the 
system  by  bleeding,  a  reason  may  be  given  why 
the  physicians,  who  do  not  bleed  in  the  depressed 
state  of  the  pulse,  have  so  few  patients  in  what  they 
call  malignant  fevers,  compared  with  those  who  use 
a  contrary  practice.  The  disease,  in  such  cases, 
being  locked  up,  is  not  permitted  to  unfold  its  true 
character ;  and  hence  patients  are  said  to  die  of 
apoplexy,  lethargy,  cholera,  dysentery,  or  nervous 
fever,  who,  under  a  different  treatment,  would  have 
exhibited  all  the  marks  of  an  ordinary  malignant 
fever. 

In  obviating  the  objections  to  blood-letting  from 
its  apparent  evils,  I  have  said  nothing  of  the  appa- 
rent bad  effects  of  other  remedies.  A  nausea  is 
often  rendered  worse  by  an  emetic,  and  pains  in  the 


DEFENCE    OF    BLOOD-LETTING.  301 

bowels  are  increased  by  a  purge.  But  these  reme- 
dies notwithstanding  maintain,  and  justly  too,  a 
high  character  among  physicians. 

19.  Bleeding  has  been  accused  of  bringing  on  a 
nervous,  or  the  chronic  state  of  fever.  The  use 
of  this  remedy,  in  a  degree  so  moderate  as  to  obvi- 
ate the  putrid  or  gangrenous  state  of  fever  only, 
may  induce  the  chronic  state  of  fever ;  for  it  is  the 
effect,  in  this  case,  of  the  remains  of  inflammatory 
diathesis  in  the  blood-vessels ;  but  when  blood  is 
drawn  proportioned  to  the  morbid  action  in  the  sys- 
tem, it  is  impossible  for  a  chronic  fever  to  be  pro- 
duced by  it.  Even  the  excessive  use  of  blood-let- 
ting, however  injurious  it  may  be  in  other  respects, 
cannot  produce  a  chronic  fever,  for  it  destroys 
morbid  action  altogether  in  the  blood-vessels. 

20.  Bleeding  has  been  charged  with  being  a 
weakening  remedy.  I  grant  that  it  is  so,  and  in 
this,  its  merit  chiefly  consists.  The  excessive  mor- 
bid action  of  the  blood-vessels  must  be  subdued 
in  part,  in  a  fever,  before  stimulating  remedies  can 
be  given  with  safety  or  advantage.  Now  this  is 
usually  attempted  by  depleting  medicines,  to  be 
mentioned  hereafter,  or  it  is  left  to  time  and  nature, 
all  of  which  are  frequently  either  deficient,  or  exces- 
sive in  their  operations  ;  whereas  bleeding,  by  sud- 


302  DEFENCE    OF    BLOOD-LETTING. 

denly  reducing  the  morbid  action  of  the  blood- 
vessels to  a  wished- for  point  of  debility,  saves  a 
great  and  unnecessary  waste  of  excitability,  and 
thus  prepares  the  body  for  the  exhibition  of  such 
cordial  remedies  as  are  proper  to  remove  the  debi- 
lity which  predisposed  to  the  fever. 

21.  It  has  been  said  that  bleeding  renders  the 
habitual  use  of  it  necessary  to  health  and  life.  This 
objection  to  blood-letting  is  founded  upon  an  igno- 
rance of  the  difference  between  the  healthy,  and 
morbid  action  of  the  blood-vessels.  Where  blood 
is  drawn  in  health,  such  a  relaxation  is  induced  in 
the  blood-vessels,  as  to  favour  the  formation  of 
plethora,  which  may  require  habitual  bleeding  to 
remove  it ;  but  where  blood  is  drawn  only  in  the 
inflammatory  state  of  fever,  the  blood-vessels  are 
reduced  from  a  morbid  degree  of  strength  to  that 
which  is  natural,  in  which  state  no  predisposition 
to  plethora  is  created,  and  no  foundation  laid  for 
periodical  blood-letting.  But  there  are  cases  which 
require  even  this  evil,  to  prevent  a  greater.  Thus 
we  cure  a  strangulated  hernia,  when  no  fever  at- 
tends, by  the  most  profuse  bleeding.  The  ple- 
thora and  predisposition  to  disease  which  follow  it 
are  trifling,  compared  with  preventing  certain  and 
sudden  death. 


DEFENCE    OF    BLOOD-LETTING.  303 

22.  Bleeding  has  been  accused  of  bringing  on  an 
intermitting  fever.  This  is  so  far  from  being  an 
objection  to  it,  that  it  should  be  considered  as  a 
new  argument  in  its  favour ;  for  when  it  produces 
that  state  of  fever,  it  converts  a  latent,  and  perhaps 
a  dangerous  disease,  into  one  that  is  obvious  to  the 
senses,  and  under  the  dominion  of  medicine.  Nor 
is  it  an  objection  to  blood-letting,  that,  when  used 
in  an  inflammatory  intermittent,  it  sometimes 
changes  it  into  a  continual  fever.  An  instance  of 
die  good  effects  of  this  change  occurred  in  the 
Pennsylvania  hospital,  in  an  obstinate  tertian,  in  the 
year  1804.  The  continual  fever,  which  followed 
the  loss  of  blood,  was  cured  in  a  few  days,  and  by 
the  most  simple  remedies. 

23.  It  has  been  said  that  bleeding,  more  especi- 
ally where  it  is  copious,  predisposes  to  effusions  of 
serum  in  the  lungs,  chest,  bowels,  limbs,  and  brain. 
In  replying  to  this  objection  to  bleeding,  in  my 
public  lectures,  I  have  addressed  my  pupils  in  the 
following  language  :  u  Ask  the  poor  patients  who 
come  panting  to  the  door  of  our  hospital,  with 
swelled  legs  and  hard  bellies,  every  fall,  whether 
they  have  been  too  copiously  bled,  and  they  will 
all  tell  you,  that  no  lancet  has  come  near  their  arms. 
Ask  the  parents  who  still  mourn  the  loss  of  children 
who  have  died,  in  our  city,  of  the  internal  dropsy 


304  DEFENCE    OF    BLOOD-LETTING. 

of  the  brain,  whether  they  were  destroyed  by  ex- 
cessive blood-letting  ?  If  the  remembrance  of  the 
acute  sufferings  which  accompanied  their  sickness 
and  death  will  permit  these  parents  to  speak,  they 
will  tell  you,  that  every  medicine,  except  bleeding, 
had  been  tried  to  no  purpose  in  their  children's 
diseases.  Go  to  those  families  is  which  I  have 
practised  for  many  years,  and  inquire,  whether 
there  is  a  living  or  a  dead  instance  of  dropsy  having 
followed,  in  any  one  of  them,  the  use  of  my  lancet? 
Let  the  undertakers  and  grave-diggers  bear  witness 
against  me,  if  I  have  ever,  in  the  course  of  my 
practice,  conveyed  the  body  of  a  single  dropsical 
patient  into  their  hands,  by  excessive  blood-letting  ? 
No.  Dropsies,  like  abscesses  and  gangrenous  erup- 
tions upon  the  skin,  arise,  in  most  cases,  from  the 
iv ant  of  sufficient  bleeding  in  inflammatory  diseases. 
Debility,  whether  induced  by  action  or  abstraction, 
seldom  disposes  to  effusion.  Who  ever  heard  of 
dropsy  succeeding  famine?  And  how  rarely  do 
we  see  it  accompany  the  extreme  debility  of  old 
age?" 

"  If  ever  bleeding  kills,"  says  Botallus,  either 
directly  or  indirectly,  through  the  instrumentality 
of  other  diseases,  "  it  is  not  from  its  excess,  but 
because  it  is  not  drawn  in  a  sufficient  quantity,  or 


JDEFENCE    OF    BLOOD-LETTING.  305 

at  a  proper  time*."  And,  again,  says  this  excel- 
lent writer,  "  One  hundred  thousand  men  perish 
from  the  want  of  blood-letting,  or  from  its  being 
used  out  of  time,  to  one  who  perishes  from  too 
much  bleeding,  prescribed  by  a  physicianf." 

It  is  remarkable,  that  the  dread  of  producing  a 
dropsy  by  bleeding,  is  confined  chiefly  to  its  use'in 
malignant  fevers ;  for  the  men  who  urge  this  ob- 
jection to  it,  do  not  hesitate  to  draw  four  or  five 
quarts  of  blood  in  the  cure  of  the  pleurisy.  The 
habitual  association  of  the  lancet  with  this  disease, 
has  often  caused  me  to  rejoice  when  I  have  heard 
a  patient  complain  of  a  pain  in  his  side,  in  a  malig- 
nant fever.  It  insured  to  me  his  consent  to  the 
frequent  use  of  the  lancet,  and  it  protected  me, 
when  it  was  used  unsuccessfully,  from  the  cla- 
mours of  the  public,  for  few  people  censure  copious 
bleeding  in  a  pleurisy. 

24.  Against  blood-letting  it  has  been  urged,  that 
the  Indians  of  our  country  cure  their  inflammatory 
fevers  without  it.  To  relieve  myself  from  the  dis- 
tressing obloquy  to  which  my  use  of  this  remedy 
formerly  exposed  me,  I  have  carefully  sought  for, 

*  Cap.  viii.  §  4. 

t  Cap.  xxxvi.  §  4. 
VOL.    IV.  2  O^ 


306  DEFENCE    OF    BLOOD-LEfTrKC. 

and  examined  their  remedies  for  those  fevers,  with 
a  sincere  desire  to  adopt  them ;  but  my  inquiries 
have  convinced  me,  that  they  are  not  only  dispro- 
portioned  to  the  habits  and  diseases  of  civilized  life, 
but  that  they  are  far  less  successful  than  blood-let- 
ting, in  curing  the  inflammatory  fevers  which  oc- 
cur among  the  Indians  themselves. 

25.  Evacuating  remedies  of  another  kind  have 
been  said  to  be  more  safe  than  bleeding,  and  equal- 
ly effectual,  in  reducing  the  inflammatory  state  of 
fever.  I  shall  enumerate  each  of  these  evacuating 
remedies,  and  then  draw  a  comparative  view  of 
their  effects  with  blood-letting.     They  are, 

I.  Vomits. 

II.  Purges. 

III.  Sweats. 

IV.  Salivation.     And, 

V.  Blisters. 


I.  Vomits  have  often  been  effectual  in  curing 
fevers  of  a  mild  character.  They  discharge  offen- 
sive and  irritating  matters  from  the  stomach ;  they 


DEFENCE    OF    BLOOD-LETTING.  307 

lessen  the  fulness  of  the  blood-vessels,  by  deter- 
mining the  serum  of  the  blood  through  the  pores ; 
and  they  equalize  the  excitement  of  the  system,  by 
inviting  its  excessive  degrees  from  the  blood-ves- 
sels to  the  stomach  and  muscles.     But  they  are, 

1.  Uncertain  in  their  operation,  from  the  torpor 
induced  by  the  fever  upon  the  stomach. 

2.  They  are  unsafe  in  many  conditions  of  the 
system,  as  in  pregnancy,  and  a  disposition  to  apo- 
plexy and  ruptures.  Life  has  sometimes  been 
destroyed  by  their  inducing  cramp,  haemorrhage, 
and  inflammation  in  the  stomach. 

3.  They  are  not  subject  to  the  controul  of  a  phy- 
sician, often  operating  more,  or  less  than  was  intend- 
ed by  him,  or  indicated  by  the  disease. 

4.  They  are  often  ineffectual  in  mild,  and  always 
so  in  fevers  of  great  morbid  action. 

II.  Purges  are  useful  in  discharging  acrid  feces 
and  bile  from  the  bowels  in  fevers.  They  act, 
moreover,  by  creating  an  artificial  weak  part,  and 
thus  invite  morbid  excitement  from  the  blood-ves- 
sels to  the  bowels.    They  likewise  lessen  the  quan- 


308  DEFENCE    OF    BLOOD-LETTING. 

tity  of  blood,  by  preventing  fresh  accessions  ot 
chyle  being  added  to  it ;  but  like  vomits  they  are, 

1.  Uncertain  in  their  operation ;  and  from  the 
same  cause.  Many  ounces  of  salts  and  castor  oil, 
and  whole  drachms  of  calomel  and  jalap,  have  often 
been  given,  without  effect,  to  remove  the  costive- 
ness  which  is  connected  with  the  malignant  state  of 
fever. 

2.  They  are  not  subject  to  the  direction  of  a 
physician,  with  respect  to  the  time  of  their  opera- 
tion, or  the  quantity  or  quality  of  matter  they  are 
intended  to  discharge  from  the  bowels. 

3.  They  are  unsafe  in  the  advanced  stage  of  fe- 
vers. Dr.  Physick  informed  me,  that  three  patients 
died  in  the  water-closet,  under  the  operation  of 
purges,  in  St.  George's  hospital,  during  his  attend- 
ance upon  it.  I  have  seen  death,  in  several  instan- 
ces, succeed  a  plentiful  spontaneous  stool  in  debili- 
tated habits. 

III.  Sweating  was  introduced  into  practice  at  a 
time  when  morbific  matter  was  supposed  to  be  the 
proximate  cause  of  fever.  It  acts,  not  by  expelling 
any  thing  exclusively  morbid  from  the  blood,  but 


DEFENCE    OF    BLOOD-LETTING.  309 

by  abstracting  a  portion  of  its  fluid  parts,  and  thus 
reducing  the  action  of  the  blood-vessels.  This 
mode  of  curing  fever  is  still  fashionable  in  genteel 
life.  It  excites  no  fear,  and  offends  no  sense.  The 
sweating  remedies  have  been  numerous,  and  fa- 
shion has  reigned  as  much  among  them,  as  in 
other  things.  Alexipharmic  waters,  and  powders, 
and  all  the  train  of  sudorific  medicines,  have  lately- 
yielded  to  the  different  preparations  of  antimony, 
particularly  to  James's  powder.  I  object  to  them 
all, 

1.  Because  they  are  uncertain ;  large  and  re- 
peated doses  of  them  being  often  given  to  no  pur- 
pose. 

2.  Because  they  are  slow,  and  disagreeable, 
where  they  succeed  in  curing  fever. 

3.  Because,  like  vomits  and  purges,  they  are  not 
under  the  direction  of  a  physician,  with  respect  to 
the  quantity  of  fluid  discharged  by  them. 

4.  Because  they  are  sometimes,  even  when  most 
profuse,  ineffectual  in  the  cure  of  fever. 

5.  The  preparations  of  antimony,  lately  employ- 
ed for  the  purpose  of  exciting  sweats,  are  by  no 


310  DEFENCE    OF    BLOOD-LETTING. 

means  safe.  They  sometimes  convulse  the  sys- 
tern  by  a  violent  puking.  Even  the  boasted  James's 
powder  has  done  great  mischief.  Dr.  Goldsmith 
and  Mr.  Howard,  it  is  said,  were  destroyed  by  it. 

None  of  these  objections  to  sweating  remedies 
are  intended  to  dissuade  from  their  use,  when  na- 
ture shows  a  disposition  to  throw  off  a  fever  by  the 
pores  of  the  skin ;  but,  even  then,  they  often  re- 
quire the  aid  of  bleeding  to  render  them  effectual 
for  that  purpose. 

IV.  Mercury,  the  Sampson  of  the  materia  me. 
dica,  after  having  subdued  the  venereal  disease,  the 
tetanus,  and  many  other  formidable  diseases,  has 
lately  added  to  its  triumphs  and  reputation,  by 
overcoming  the  inflammatory  and  malignant  state 
of  fever.  I  shall  confine  myself,  in  this  place,  to 
its  depleting  operation,  when  it  acts  by  exciting  a 
salivation.  From  half  a  pound  to  two  pounds  of 
fluid  are  discharged  by  it  in  a  day.  The  depletion 
in  this  way  is  gradual,  whereby  fainting  is  prevent- 
ed. By  exciting  and  inflaming  the  glands  of  the 
mouth  and  throat,  excitement  and  inflammation  are 
abstracted  from  more  vital  parts.  In  morbid  coiir 
gestion  and  excitement  in  the  brain,  a  salivation  is 
of  eminent  service,  from  the  proximity  of  the  di*?, 


DEFENCE    OF    BLOOD-LETTING.  311 

charge  to  the  part  affected.     But  I  object  to  it,  as 
an  exclusive  evacuant  in  the  cure  of  fever, 

1.  Because  it  is  sometimes  impossible,  by  the 
largest  doses  of  mercury,  to  excite  it,  when  the 
exigences  of  the  system  render  it  most  necessary. 

2.  Because  it  is  not  so  quick  in  its  operation,  as 
to  be  proportioned  to  the  rapid  progress  of  the  ma- 
lignant state  of  fever. 

3.  Because  it  is  at  all  times  a  disagreeable,  and 
frequently  a  painful  remedy,  more  especially  where 
the  teeth  are  decayed. 

4.  Because  it  cannot  be  proportioned  in  its  dura- 
tion, or  in  the  quantity  of  fluid  discharged  by  it,  to 
the  violence  or  changes  in  the  fever. 

Dr.  Chisholm  relied,  for  the  cure  of  the  Beullam 
fever  at  Grenada,  chiefly  upon  this  evacuation.  I 
have  mentioned  the  ratio  of  success  which  attended 
it. 

V.   Blisters  are  useful  in  depleting  from  those 
parts  which  are  the  seats  of  topical  inflammation. 
The  relief  obtained  by  them  in  this  way  more  than 
balances  their  stimulus  upon  the  whole  system. 


312  DEFENCE    OF    BLOOD-LETTING. 

need  hardly  say,  that  their  effects  in  reducing  the 
morbid  and  excessive  action  of  the  blood-vessels 
are  very  feeble.  To  depend  upon  them  in  cases  of 
great  inflammatory  action,  is  as  unwise  as  it  would 
be  to  attempt  to  bale  the  water  from  a  leaky  and 
sinking  ship  by  the  hollow  of  the  hand,  instead  of 
discharging  it  by  two  or  three  pumps. 

VI.  Abstemious  diet  has  sometimes  been  pre- 
scribed as  a  remedy  for  fever.  It  acts  directly  by 
the  abstraction  of  <he  stimulus  of  food  from  the 
stomach,  and  indirectly  by  lessening  the  quantity  of 
blood.  It  can  bear  no  proportion,  in  its  effects,  to 
the  rapidity  and  violence  of  an  inflammatory  fever. 
In  chronic  fever,  such  as  occurs  in  the  pulmonary 
consumption,  it  has  often  been  tried  to  no  purpose. 
Long  before  it  reduces  the  pulse,  it  often  induces 
such  a  relaxation  of  the  tone  of  the  stomach  and 
bowels  as  to  accelerate  death.  To  depend  upon  it 
therefore  in  the  cure  of  inflammatory  fever,  whether 
acute  or  chronic,  is  like  trusting  to  the  rays  of  the 
sun  to  exhale  the  water  of  an  overflowing  tide,  in- 
stead of  draining  it  off  immediately,  by  digging  a 
hole  in  the  ground.  But  there  are  cases  in  which  the 
blood-vessels  become  so  insolated,  that  they  refuse 
to  yield  their  morbid  excitement  to  depletion  from 
any  outlet,  except  from  themselves.  I  attended  a 
sailor,  in  the  Pennsylvania  hospital,  in  1799,  who 


DEFENCE    OF    BLOOD-LETTING.  313 

was  affected  with  deafness,  attended  with  a  full  and 
tense  pulse.  I  prescribed  for  it,  purging,  blisters, 
and  low  diet,  but  without  any  effect.  Perceiving 
no  change  in  his  pulse,  nor  in  his  disease,  from  those 
remedies,  I  ordered  him  to  lose  ten  ounces  of 
blood.  The  relief  obtained  by  this  evacuation  in- 
duced me  to  repeat  it.  By  means  of  six  bleedings 
he  was  perfectly  cured,  without  the  aid  of  any  other 
remedy. 

Bleeding  has  great  advantages  over  every  mode 
of  depleting  that  has  been  mentioned. 

1.  It  abstracts  one  of  the  exciting  causes,  viz. 
the  stimulus  of  the  blood,  from  the  seat  of  fever.  I 
have  formerly  illustrated  this  advantage  of  blood- 
letting, by  comparing  it  to  the  abstraction  of  a  grain 
of  sand  from  the  eye  to  cure  an  opthalmia.  The 
other  depleting  remedies  are  as  indirect  and  circui- 
tous in  their  operation  in  curing  fever,  as  vomits 
and  purges  would  be  to  remove  an  inflammation  in 
the  eye,  while  the  grain  of  sand  continued  to  irri- 
tate it. 

. 

2.  Blood-letting  is  quick  in  its  operation,  and 
may  be  accommodated  to  the  rapidity  of  fever, 
when  it  manifests  itself  in  apoplexy,  palsy,  and  syn- 
cope. 

VOL.    IV.  2    R 


314  DEFENCE    OF    BLOOD-LETTING. 

3.  It  is  under  the  command  of  a  physician.  He 
may  bleed  when  and  where  he  pleases,  and  may 
suit  the  quantity  of  blood  he  draws,  exactly  to  the 
condition  of  his  patient's  system. 

4.  It  may  be  performed  with  the  least  attendance 
of  nurses  or  friends.  This  is  of  great  importance 
to  the  poor  at  all  times,  and  to  the  rich  during  the 
prevalence  of  mortal  epidemics. 

5.  It  disturbs  the  system  much  less  than  any  of 
the  other  modes  of  depleting,  and  therefore  is  best 
accommodated  to  that  state  of  the  system,  in  which 
patients  are  in  danger  of  fainting  or  dying  upon  be- 
ing moved. 

6.  It  is  a  more  delicate  depleting  remedy  than 
most  of  those  which  have  been  mentioned,  particu? 
larly  vomits,  purges,  and  a  salivation. 

7.  There  is  no  immediate  danger  to  life  from  its 
use.  Patients  have  sometimes  died  under  the  ope- 
ration of  vomits  and  purges,  but  I  never  saw  nor 
heard  an  instance  of  a  patient's  dying  in  a  fainty  fit, 
brought  on  by  bleeding. 

8.  It  is  less  weakening,  when  used  to  the  extent 
that  is  necessary  to  cure,  than  the  same  degrees  of 
vomiting,  purging,  and  sweating. 


DEFENCE    OF    BLOOD-LETTING.  315 

9.  Convalescence  is  more  rapid  and  more  per- 
fect after  bleeding,  than  after  the  successful  use  of 
any  of  the  other  evacuating  remedies. 

By  making  use  of  blood-letting  in  fevers,  we  are 
not  precluded  from  the  benefits  of  the  other  evacu- 
ating remedies.  Some  of  them  are  rendered  more 
certain  and  more  effectual  by  it,  and  there  are  cases 
of  fever,  in  which  the  combined  or  successive  ap- 
plication of  them  all  is  barely  sufficient  to  save  life. 

To  rely  upon  any  one  evacuating  remedy,  to  the 
exclusion  of  the  others,  is  like  trusting  to  a  pair  of 
oars  in  a  sea  voyage,  instead  of  spreading  every  sail 
of  a  ship. 

I  suspect  the  disputes  about  the  eligibility  of  the 
different  remedies  which  have  been  mentioned,  have 
arisen  from  an  ignorance  that  they  all  belong  to  one 
class,  and  that  they  differ  only  in  their  force  and 
manner  of  operation.  Thus  the  physicians  of  the 
last  century  ascribed  different  virtues  to  salts  of  dif- 
ferent names,  which  the  chemises  of  the  present  day 
have  taught  us  are  exactly  the  same,  and  differ  only 
in  the  manner  of  their  being  prepared. 

Having  replied  to  the  principal  objections  to 
blood-letting,  and  stated  its  comparative  advantages 


316  DEFENCE    OF    BLOOD-LETTING. 

over  other  modes  of  depletion,  I  proceed  next  to 
mention  the  circumstances  which  should  regulate 
the  use  of  it.     These  are, 

I.  The  state  of  the  pulse. 

The  following  states  of  the  pulse  indicate  the  ne- 
cessity of  bleeding. 

1.  A  full,  frequent,  and  tense  pulse,  such  as  oc- 
curs in  the  pulmonary,  rheumatic,  gouty,  phrenitic, 
and  maniacal  states  of  fever. 

2.  A  full,  frequent,  and  jerking  pulse,  without 
tension,  such  as  frequently  occurs  in  the  vertigi- 
nous, paralytic,  apoplectic,  and  hydropic  states  of 
fever. 

3.  A  small,  frequent,  but  tense  pulse,  such  as 
occurs  in  the  chronic,  pulmonary,  and  rheumatic 
states  of  fever. 

4.  A  tense  and  quick  pulse,  without  much  preter- 
natural frequency.  This  state  of  the  pulse  is  com- 
mon in  the  vellow  fever. 

5.  A  slow  but  tense  pulse,  such  as  occurs  in  the 
apoplectic,  hydrocephalic,  and  malignant  states  of 


DEFENCE    OF    BLOOD-LETTING.  317 

fever,  in  which  its  strokes  are  from  60  to  9,  in  a 
minute. 

6\  An  uncommonly  frequent  pulse,  without 
much  tension,  beating  from  120  to  170  or  180 
strokes  in  a  minute.  This  state  of  the  pulse  oc- 
curs likewise  in  the  malignant  states  of  fever. 

7.  A  soft  pulse,  without  much  frequency  or  ful- 
ness. I  have  met  with  this  state  of  the  pulse  in  af- 
fections of  the  brain,  and  in  that  state  of  pulmonary 
fever  which  is  known  by  the  name  of  pneumonia 
notha.  It  sometimes,  I  have  remarked,  becomes 
tense  after  bleeding. 

8.  An  intermitting  pulse, 

9.  A  depressed  pulse. 

10.  An  imperceptible  pulse.  The  slow,  inter- 
mitting, depressed,  and  imperceptible  states  of  the 
pulse  are  supposed  exclusively  to  indicate  conges- 
tion in  the  brain.  But  they  are  all,  I  believe,  occa- 
sioned likewise  by  great  excess  of  stimulus  acting 
upon  the  heart  and  arteries.  A  pulse  more  tense 
in  one  arm  than  in  the  other,  I  have  generally  found 
to  attend  a  morbid  state  of  the  brain.  Much  yet 
remains  to  be  known  of  the  signs  of  a  disease  in  the 


318  DEFENCE    OF    BLOOD-LETTING. 

brain,  by  the  states  of  the  pulse ;  hence  Mr.  Hun- 
ter has  justly  remarked,  that  "  In  inflammation  of 
the  brain,  the  pulse  varies  more  than  in  inflamma- 
tions of  any  other  part ;  and  perhaps  we  are  led  to 
judge  of  inflammation  there,  more  from  other  symp- 
toms than  the  pulse*." 

The  slow,  uncommonly  frequent,  intermitting, 
and  imperceptible  states  of  the  pulse,  which  require 
bleeding,  may  be  distinguished  from  the  same  states 
of  the  pulse,  which  arise  from  an  exhausted  state 
of  the  system,  and  that  forbid  bleeding,  by  the  fol- 
lowing marks  : 

1.  They  occur  in  the  beginning  of  a  fever. 

2.  They  occur  in  the  paroxysms  of  fevers  which 
have  remissions  and  exacerbations. 

3.  They  sometimes  occur  after  blood-letting, 
from  causes  formerly  mentioned. 

4.  They  sometimes  occur,  and  continue  during 
the  whole  course  of  an  inflammation  of  the  stomach 
and  bowels.     And, 

*  Treatise  on  Inflammation,  cha^p.  tii.  9. 


i 
DEFENCE    OF     BLOOD-LETTING.  319 

5.  They  occur  in  relapses,  after  the  crisis  of  a 
fever. 

The  other  states  of  the  pulse  indicate  bleeding  in 
every  stage  of  fever,  and  in  every  condition  of  the 
system.  I  have  taken  notice,  in  another  place,  of 
the  circumstances  which  render  it  proper  in  the  ad- 
vanced stage  of  chronic  fever. 

If  all  the  states  of  pulse  which  have  been  enu- 
merated indicate  bleeding,  it  must  be  an  affecting 
consideration  to  reflect,  how  many  lives  have  been 
lost,  by  physicians  limiting  the  use  of  the  lancet 
only  to  the  tense  or  full  pulse  ! 

I  wish  it  comported  with  the  proposed  limits  of 
this  essay  to  illustrate  and  establish,  by  the  recital 
of  cases,  the  truth  of  these  remarks  upon  the  indi- 
cations of  bleeding  from  the  pulse.  It  communi- 
cates much  more  knowledge  of  the  state  of  the 
system  than  any  other  sign  of  disease.  Its  fre- 
quency (unconnected  with  its  other  states),  being 
under  the  influence  of  diet,  motion,  and  the  pas- 
sions of  the  mind,  is  of  the  least  consequence.  In 
counting  the  number  of  its  strokes,  we  are  apt  to 
be  diverted  from  attending  to  its  irregularity  and 
force ;  and  in  these,  it  should  always  be  remem- 
bered, fever  chieflv  consists.     The  knowledge  ac- 


320  DEFENCE    OF    BLOOD-LETTING. 

quired  by  attending  to  these  states  of  the  pulse  is 
so  definite  and  useful,  and  the  circumstances  which 
seduce  from  a  due  attention  to  them  are  so  erro- 
neous in  their  indications,  that  I  have  sometimes 
wished  the  Chinese  custom  of  prescribing,  from 
feeling  the  pulse  only,  without  seeing  or  convers- 
ing with  the  patient,  were  imposed  upon  all  phy- 
sicians. 

To  render  the  knowledge  of  the  indications  of 
blood-letting,  from  the  state  of  the  pulse,  as  definite 
and  correct  as  possible,  I  shall  add,  for  the  benefit 
of  young  practitioners,  the  following  directions  for 
feeling  it. 

1.  Let  the  arm  be  placed  in  a  situation  in  which 
all  the  muscles  which  move  it  shall  be  completely 
relaxed ;  and  let  it,  at  the  same  time,  be  free  from 
the  pressure  of  the  body  upon  it. 

2.  Feel  the  pulse,  in  all  obscure  or  difficult  cases, 
in  both  arms. 

3.  Apply  all  the  fingers  of  one  hand,  when  prac- 
ticable, to  the  pulse.  For  this  purpose,  it  will  be 
most  convenient  to  feel  the  pulse  of  the  right  hand 
with  your  left,  and  of  the  left  hand  with  your  right. 


DEFENCE    OF    BLOOD-LETTING*  321 

4.  Do  not  decide  upon  blood-letting,  in  difficult 
cases,  until  you  have  felt  the  pulse  for  some  time. 
The  Chinese  physicians  never  prescribe  until  they 
have  counted  49  strokes. 

5.  Feel  the  pulse  at  the  intervals  of  four  or  five 
minutes,  when  you  suspect  that  its  force  has  been 
varied  by  any  circumstance  not  connected  with  the 
disease,  such  as  emotions  of  the  mind,  exercise, 
eating,  drinking,  and  the  like. 

6.  Feel  the  pulsations  of  the  arteries  in  the  tem- 
ples and  in  the  neck,  when  the  pulse  is  depressed 
or  imperceptible  in  the  wrists. 

7.  Request  silence  in  a  sick  room,  and  close 
your  eyes,  in  feeling  a  pulse  in  difficult  cases.  By 
so  doing,  you  will  concentrate  the  sensations  of 
your  ears  and  eyes,  in  your  fingers. 

In  judging  of  the  states  of  the  pulse  which  have 
been  enumerated,  it  will  be  necessary  always  to  re- 
member the  natural  difference^  in  its  frequency  and 
force,  in  old  people  and  children ;  also  in  the  morn- 
ing and  evening,  and  in  the  sleeping  and  waking 
states  of  the  system. 

vol.   iv.  2  s 


322  DEFENCE    OF    BLOOD-LETTING. 

Much  yet  remains  to  be  known  upon  this  sub- 
ject. I  have  mentioned  the  different  states  of  the 
pulse,  which  call  for  bleeding,  but  it  is  more  diffi- 
cult to  know  when  to  prescribe  it,  when  the  pulse 
imparts  no  sign  of  disease.  In  general  it  may  be 
remarked,  where  the  disease  is  recent  y  the  part  af- 
fected important  to  life,  and  incapable  of  sustaining 
violent  morbid  action  long,  without  danger  of  dis- 
organization, where  pain  is  great,  and  respiration 
difficult,  the  pulse  may  be  disregarded  in  the  use  of 
the  lancet. 

But  to  return. 

II.  Regard  should  be  had  to  the  character  of  the 
reigning  epidemic,  in  deciding  upon  blood-letting. 
If  the  prevailing  fever  be  of  a  highly  inflammatory 
nature,  bleeding  may  be  used  with  more  safety,  in 
cases  where  the  indications  of  it  from  the  pulse  are 
somewhat  doubtful.  The  character  of  a  previous 
epidemic  should  likewise  direct  the  use  of  the  lan- 
cet. The  pestilential  fever  which  followed  the 
plague  in  London,  in  1665,  Dr.  Sydenham  says, 
yielded  only  to  blood-letting.  It  is  equally  neces- 
sarv  in  all  the  febrile  diseases  which  succeed  ma- 
lignant  fevers. 


DEFENCE    OF    BLOOD-LETTING.  323 

III.  Regard  should  be  had  to  the  weather  and 
season  of  the  year.  Dr.  Hillary  and  Dr.  Huxham 
both  say  it  is  much  more  necessary  in  dry,  than  in 
wet  weather,  and,  all  physicians  know,  it  is  more 
copiously  indicated  in  the  spring  and  autumn,  than 
in  summer  and  winter. 

IV.  The  constitution  of  a  patient,  and  more  es- 
pecially his  habits  with  respect  to  blood-letting, 
should  be  taken  into  consideration,  in  prescribing 
it.  If  he  be  plethoric,  and  accustomed  to  bleed- 
ing in  former  indispositions,  it  will  be  more  neces- 
sary, than  in  opposite  states  and  habits  of  the  sys- 
tem.    Nature  will  expect  it. 

V.  The  corpulency  of  a  patient  should  regulate 
the  use  of  the  lancet.  A  butcher  of  great  observa- 
tion informed  me,  that  a  fat  ox  did  not  yield  more 
than  from  one  half,  to  one  third  of  the  quantity  of 
blood  of  a  lean  one,  of  the  same  size  of  bone,  and  it 
is  well  known,  that  the  loss  of  a  small  quantity  of 
blood,  after  cutting  off  the  head  of  a  fowl,  is  always 
a  sign  of  its  being  fit  for  the  table.  The  pressure 
of  fat  upon  the  blood-vessels  produces  the  same 
effects  in  the  human  species  that  it  does  in  those 
animals ;  of  course,  less  blood  should  be  drawn 
from  fat,  than  from  lean  people,  under  equal  circum- 
stances of  disease. 


324  DEFENCE    OF    BLOOD-LETTING. 

VI.  As  persons  have  more  or  less  blood  in  their 
vessels,  according  to  their  size,  less  blood  should 
be  drawn,  under  equal  circumstances,  from  small 
than  large  people. 

VII.  Regard  should  be  had  to  the  age  of  adults 
in  prescribing  bleeding.  In  persons  between  fifty 
and  sixty  years  of  age,  for  reasons  formerly  men- 
tioned, more  blood  may  be  drawn  than  in  middle 
life,  in  similar  diseases.  In  persons  beyond  70,  it 
will  be  necessary  to  regulate  the  quantity  to  be 
drawn  by  other  signs  than  the  pulse,  or  the  appear- 
ances of  the  blood,  the  former  being  generally  full, 
and  sometimes  tense,  and  the  latter  often  putting  on 
the  sign  of  the  second  grade  of  morbid  action  for- 
merlv  described. 

VIII.  Regard  should  be  had  to  the  country  or 
place  from  which  persons  affected  with  fevers  have 
arrived,  in  prescribing  the  loss  of  blood.  Fevers, 
in  America,  are  more  inflammatory  than  fevers,  in 
persons  of  equal  rank,  in  Great-Britain.  A  French 
physician  once  said,  it  was  safer  to  draw  a  hogs- 
head of  wine  from  a  Frenchman's  veins,  than  a 
quarter  of  a  hundred  pounds  of  beef  from  an  Eng- 
lishman's, meaning  to  convey  an  idea  of  the  differ- 
ence in  the  grades  of  morbid  or  inflammatory  action 
in  the  diseases  of  the  inhabitants  of  France  and 


DEFENCE    OF    BLOOD-LETTING.  325 

England,  and  of  the  difference  in  the  quantity  of 
blood  proper  to  be  drawn  in  each  of  them.  A 
similar  difference  exists  between  the  grades  of 
fever  in  Great-Britain  and  America.  From  a  want 
of  attention  to  this  circumstance,  I  saw  a  common 
pleurisy  end  in  an  abscess  of  the  lungs,  in  a  sea 
captain,  in  the  city  of  London,  in  the  year  1769, 
who  was  attended  by  a  physician  of  the  first  repu- 
tation in  England.  He  was  bled  but  once.  His 
pulse  and  American  constitution  called  for  the  loss 
of  50  or  60  ounces  of  blood. 

IXc  Regard  should  be  had  to  the  structure  and 
situation  of  the  parts  diseased  with  febrile  action. 
The  brain,  from  its  importance  to  all  the  functions  of 
life,  the  rectum,  the  bladder,  and  the  trachea,  when 
inflamed,  and  the  intestines,  when  strangulated, 
from  their  being  removed  so  much  out  of  the  in- 
fluence of  the  great  circulation,  all  require  more 
copious  bleeding  than  the  same  degrees  of  disease 
in  the  lungs,  and  some  other  parts  of  the  body. 

X.  After  blood-letting  has  been  performed,  the 
appearances  of  the  blood  should  be  attended  to,  in 
order  to  judge  of  the  propriety  of  repeating  it.  I 
shall  briefly  describe  these  appearances,  and  ar- 
range them  in  the  order  in  which  they  indicate  the 


326  DEFENCE    OF    BLOOD-LETTING, 

different  degrees  of  inflammatory  diathesis,  begin- 
ning with  the  highest. 

1.  Dissolved  blood.  It  occurs  in  the  malignant 
states  of  fever.  I  have  seen  it  several  times  in  the 
pleurisy,  and  have  once  heard  of  it  in  a  case  of 
gout.  I  have  ascribed  this  decomposition  of  the 
blood  to  such  a  violent  degree  of  action  in  the 
blood-vessels,  as  to  dispose  them  to  a  paralytic 
state.  It  is  generally  considered  as  a  signal  to  lay 
aside  the  lancet.  If  it  occur  in  the  first  stage  of  a 
fever,  it  indicates  a  very  opposite  practice.  By 
repeated  bleedings,  the  vessels  recover  their  natu- 
ral action,  and  the  blood  becomes  reduced  to  its 
original  texture.  Of  this  I  have  had  frequent  ex- 
perience, since  the  year  1793.  It  required  three 
successive  bleedings  to  restore  the  blood  from  a 
dissolved,  to  a  coagulable  state,  in  Mr.  Benton.  It 
afterwards  became  very  sizy..  If  this  dissolved 
blood  appear  towards  the  close  of  a  malignant  fever, 
no  other  benefit  than  the  protraction  of  life  for  a  day 
or  two,  or  an  easy  death,  can  be  expected  from 
repeating  the  bleeding,  even  though  it  be  indicated 
by  a  tense  pulse ;  for  the  viscera  are  generally  so 
much  choaked  by  the  continuance  of  violent  action 
in  the  blood-vessels,  that  they  are  seldom  able  to 
discharge  the  blood  which  distends  them,  into  the 
cavity  in  the  vessels,  which  is  created  by  the  ab- 


DEFENCE    OF    BLOOD-LETTING.  327 

straction  of  blood  from  a  vein.  There  is  some 
variety  in  the  appearance  of  this  state  of  the  blood, 
which  indicates  more  or  less  violent  pressure  upon 
the  blood-vessels.  It  threatens  most  danger  to  life 
when  it  resembles  molasses  in  its  consistence.  The 
danger  is  less  when  the  part  which  is  dissolved  oc- 
cupies the  bottom  of  the  bowl,  and  when  its  sur- 
face is  covered  with  a  sizy  pellicle  or  coat. 

Does  not  the  restoration  of  the  blood  from  its 
disorganized  state,  by  means  of  bleeding,  suggest 
an  idea  of  a  similar  change  being  practicable  in  the 
solids,  when  they  are  disorganized  by  disease? 
And  are  we  not  led  hereby  to  an  animating  view  of 
the  extent  and  power  of  medicine  ? 

2.  Blood  of  a  scarlet  colour,  without  any  separa- 
tion into  crassamentum  or  serum,  indicates  a  se- 
cond degree  of  morbid  action.  It  occurs  likewise 
in  the  malignant  state  of  fever.  It  is  called  impro- 
perly dense  blood.     It  occurs  in  old  people. 

3.  Blood  in  which  part  of.  the  crassamentum  is 
dissolved  in  the  serum,  forming  a  resemblance  to 
what  is  called  the  lotura  carnium,  or  the  washings 
of  flesh  in  water. 


328  DEFENCE    OF    BLOOD-LETTING. 

4.  Crassamentum  sinking  to  the  bottom  of  a 
bowl  in  yellow  serum. 

5.  Crassamentum  floating  in  serum,  which  is  at 
first  turbid,  but  which  afterwards  becomes  yellow 
and  transparent,  by  depositing  certain  red  and  fiery 
particles  of  the  blood  in  the  bottom  of  the  bowl. 

6.  Sizy  blood,  or  blood  covered  with  a  buffy 
coat.  The  more  the  crassamentum  appears  in  the 
form  of  a  cup,  the  more  inflammatory  action  is  said 
to  be  indicated  by  it.  This  appearance  of  the  blood 
occurs  in  all  the  common  states  of  inflammatory 
fever.  It  occurs  too  in  the  mild  state  of  malignant 
fevers,  and  in  the  close  of  such  of  them  as  have 
been  violent.  It  is  not  always  confined  to  the 
common  inflammatory  state  of  the  pulse,  for  I  have 
observed  it  occasionally  in  most  of  the  different 
states  of  the  pulse  which  have  been  described.  The 
appearance  of  this  buffy  coat  on  the  blood  in  the 
yellow  fever  is  always  favourable.  It  shows  the 
disease  to  be  tending  from  an  uncommon  to  a  com- 
mon degree  of  inflammatory  diathesis.  It  has  been 
remarked,  that  blood  which  resembles  claret  in  its 
colour,  while  flowing,  generally  puts  on,  when  it 
cools,  a  sizy  appearance. 


DEFENCE    OF    BLOOD-LETTING.  329 

It  would  seem,  from  these  facts,  that  the  power 
of  coagulation  in  the  blood  was  lessened  in  an  ex- 
act ratio  to  the  increase  of  action  upon  the  blood- 
vessels, and  that  it  was  increased  in  proportion  to 
the  diminution  of  that  action,  to  that  degree  of  it 
which  constitutes  what  I  have  called  common  in- 
flammatory action. 

Here,  as  upon  a  former  occasion,  we  may  say 
with  concern,  if  bleeding  be  indicated  by  all  the 
appearances  of  the  blood  which  have  been  enumer- 
ated, how  many  lives  have  been  lost  by  physicians 
limiting  the  use  of  the  lancet  to  those  cases  only, 
where  the  blood  discovered  an  inflammatory  crust ! 

These  remarks  upon  the  relative  signs  of  inflam- 
matory action  in  the  blood-vessels,  should  be  ad- 
mitted with  a  recollection  that  they  are  all  liable  to 
be  varied  by  a  moderate,  or  violent  exacerbation  of 
fever,  by  the  size  of  the  stream  of  blood,  and  by 
the  heat,  coldness,  and  form  of  the  cup  into  which 
the  blood  flows.  Even  blood  drawn,  under  exactly 
equal  circumstances,  from  both  arms,  exhibited,  in 
a  case  of  pleurisy  communicated  to  me  by  Dr. 
Mitchell,  of  Kentucky,  very  different  appearances. 
That  which  was  taken  from  one  arm  was  sizy, 
while  that  which  was  taken  from  the  other  was  of 
a  scarlet  colour.     That  which  is  drawn  from  a  vein 

VOL.    iv.  2  T 


330  DEFENCE    OF    BLOOD-LETTING. 

in  the  arm,  puts  on,  likewise,  appearances  very  dif- 
ferent from  that  which  is  discharged  from  the 
bowels,  in  a  dysentery.  These  facts  were  alluded 
to  in  the  Outlines  of  the  Theory  of  Fever*,  in  order 
to  prove  that  unequal  excitement  takes  place,  not 
only  in  the  different  systems  of  the  body,  but  in 
the  same  system,  particularly  in  the  blood-vessels. 
They  likewise  show  us  the  necessity  of  attending 
to  the  state  of  the  pulse  in  both  arms,  as  well  as  in 
other  parts  of  the  body,  in  prescribing  blood-letting. 
When  time,  and  more  attention  to  that  index  of 
the  state  of  the  system  in  fevers,  shall  have  brought 
to  light  all  the  knowledge  that  the  pulse  is  capable 
of  imparting,  the  appearances  of  the  blood,  in  fe- 
vers, will  be  regarded  as  little  as  the  appearances 
of  the  urine. 

XI.  Blood-letting  should  always  be  copious 
where  there  is  danger  from  sudden  and  great  con- 
gestion or  inflammation,  in  vital  parts.  This  dan- 
ger is  indicated  most  commonly  by  pain ;  but 
there  may  be  congestion  in  the  lungs,  liver,  bowels, 
and  even  in  the  head,  without  pain.  In  these 
cases,  the  state  of  the  pulse  should  always  govern 
the  use  of  the  lancet. 

*  Vol.  Ui. 


D.EFENCE    OF    BLOOD-LETTING.  331 

XII.    What  quantity  of  blood  may  be  taken, 
with  safety,  from  a  patient  in  an  inflammatory  fever? 
To  answer  this  question  it  will  be  necessary  to  re- 
mark,  1.  That,  in  a  person  of  an  ordinary  size, 
there  are  supposed  to  be  contained  between  25  and 
28  pounds  of  bipod  ;  and  2.  That  much  more  blood 
may  be  taken  when  the  blood-vessels  are  in  a  state 
of  morbid  excitement  and  excitability,  than  at  any- 
other  time.     One  of  the  uses  of  the  blood  is  to  sti- 
mulate the  blood-vessels,  and  thereby  to  assist  in 
originating  and  preserving  animal  life.    In  a  healthy 
state  of  the  vessels,  the  whole  mass  of  the  blood  is 
necessary  for  this  purpose ;    but  in  their  state  of 
morbid  excitability,  a  much  less  quantity  of  blood 
than  what  is  natural  (perhaps  in  some  cases  four  or 
five  pounds)  are  sufficient  to  keep  up  an  equal  and 
vigorous  circulation.     Thus  very  small  portions  of 
light  and  sound  are  sufficient  to  excite  vision  and 
hearing  in  an  inflamed,  and  highly  excitable  state 
of  the  eyes  and  ears.     Thus  too,  a  single  glass  of 
wine  will  often  produce  delirium  in  a  fever  in  a 
man,  who,  when  in  health,  is  in  the  habit  of  drink- 
ing a  bottle  every  day,  without  having  his  pulse 
quickened  by  it. 

An  ignorance  of  the  quantity  of  blood  which  has 
been  drawn  by  design,  or  lost  by  accident,  has  con- 
tributed very  much  to  encourage  prejudices  against 


332       -    DEFENCE     OF    BLOOD-LETTING. 

blood-letting.  Mr.  Cline  drew  320  ounces  of  blood 
in  20  days  from  a  patient  in  St.  Thomas's  hospital, 
who  laboured  under  a  contusion  of  the  head.  But 
this  quantity  is  small  compared  with  the  quantity 
lost  by  a  number  of  persons,  whose  cases  are  record- 
ed by  Dr.  Haller*.  I  shall  mention  a  few  of  them. 
One  person  lost  9  pounds  of  blood,  a  second  12, 
a  third  18,  and  a  fourth  22,  from  the  nose,  at  one 
time.  A  fifth  lost  12  pounds  by  vomiting  in  one 
night,  and  a  sixth  22  from  the  lungs.  A  gentle- 
man at  Angola  lost  between  3  and  4  pounds  daily 
from  his  nose.  To  cure  it,  he  was  bled  97  times 
in  one  year.  A  young  woman  was  bled  1020  times 
in  19  years,  to  cure  her  of  plethora  which  disposed 
her  to  hysteria.  Another  young  woman  lost  125 
ounces  of  blood,  by  a  natural  haemorrhage,  every 
month.  To  cure  it,  she  was  bled  every  day,  and 
every  other  day,  for  14  months.  In  none  of  these 
instances,  was  death  the  consequence  of  these  great 
evacuations  of  blood.  On  the  contrary,  all  the 
persons  alluded  to,  recovered.  Many  similar  in- 
stances of  the  safety,  and  even  benefit  of  profuse 
discharges  of  blood,  by  nature  and  art,  might  be 
mentioned  from  other  authors.  I  shall  insert  only 
one  more,  which  shall  be  taken  from  Dr.  Syden- 
ham's account  of  the  cure  of  the  plague.    "  Among 

*  Elementa  Physiologic,  vol.  iv.  p.  45. 


DEFENCE    OF    BLOOD-LETTING.  333 

the  other  calamities  of  the  civil  war  which  afflicted 
this  nation,  the  plague  also  raged  in  several  places, 
and  was  brought  by  accident  from  another  place  to 
Dunstar  Castle,  in  Somersetshire,  where  some  of 
the  soldiers  dying  suddenly,  with  an  eruption  of 
spots,  it  likewise  seized  several  others.  It  happened 
at  that  time  that  a  surgeon,  who  had  travelled  much 
in  foreign  parts,  was  in  the  service  there,  and  ap- 
plied to  the  governor  for  leave  to  assist  his  fellow- 
soldiers  who  were  afflicted  with  this  dreadful  dis- 
ease, in  the  best  manner  he  was  able  ;  which  being- 
granted,  he  took  so  large  a  quantity  of  blood  from 
every  one  at  the  beginning  of  the  disease,  and  be- 
fore any  swelling  was  perceived,  that  they  were 
ready  to  faint,  and  drop  down,  for  he  bled  them  all 
standing,  and  in  the  open  air,  and  had  no  vessel  to 
measure  the  blood,  which  falling  on  the  ground, 
the  quantity  each  person  lost  could  not,  of  course, 
be  known.  The  operation  being  over,  he  ordered 
them  to  lie  in  their  tents ;  and  though  he  gave  no 
kind  of  remedy  after  bleeding,  yet  of  the  numbers 
that  were  thus  treated,  not  a  single  person  died.  I 
had  this  relation  from  Colonel  Francis  Windham, 
a  gentleman  of  great  honour  and  veracity,  and  at 
this  time  governor  of  the  castle*.' » 

*  Vol.  i.  p.  131, 


334  DEFENCE    OF    BLOOD-LETTING. 

Again.  An  ignorance  of  the  rapid  manner  in 
which  blood  is  regenerated,  when  lost  or  drawn, 
has  helped  to  keep  up  prejudices  against  blood-let- 
ting. A  person  (Dr.  Haller  says)  lost  five  pounds 
of  blood  daily  from  the  haemorrhoidal  vessels  for 
62  days,  and  another  75  pounds  of  blood  in  10 
days.  The  loss  each  day  was  supplied  by  fresh 
quantities  of  aliment. 

These  facts,  I  hope,  will  be  sufficient  to  establish 
the  safety  and  advantages  of  plentiful  blood-letting, 
in  cases  of  violent  fever ;  also  to  show  the  fallacy 
and  danger  of  that  practice  which  attempts  the  cure 
of  such  cases  of  fever,  by  what  is  called  moderate 
bleeding.  There  are,  it  has  been  said,  no  half 
truths  in  government.  It  is  equally  true,  that  there 
are  no  half  truths  in  medicine.  This  half-way  prac- 
tice of  moderate  bleeding,  has  kept  up  the  morta- 
lity of  pestilential  fevers,  in  all  ages,  and  in  all  coun- 
tries. I  have  combated  this  practice  elsewhere*,  and 
have  asserted,  upon  the  authority  of  Dr.  Syden- 
ham, that  it  is  much  better  not  to  bleed  at  all,  than 
to  draw  blood  disproportioned  in  quantity  to  the 
violence  of  the  fever.     If  the  state  of  the  pulse  be 

*  Account  of  the  Yellow  Fever  in  1793. 


DEFENCE    OF    BLOOD-LETTING.  335 

our  guide,  the  continuance  of  its  inflammatory  ac- 
tion, after  the  loss  of  even  100  ounces  of  blood,  in- 
dicates the  necessity  of  more  bleeding,  as  much  as 
it  did  the  first  time  a  vein  was  opened.  In  the 
use  of  this  remedy  it  may  be  truly  said,  as  in  many 
of  the  enterprizes  of  life,  that  nothing  is  done,  while 
any  thing  remains  to  be  done.  Bleeding  should  be 
repeated  while  the  symptoms  which  first  indicated 
it  continue,  should  it  be  until  four-fifths  of  the  blood 
contained  in  the  body  are  drawn  away.  In  this 
manner  we  act  in  the  use  of  other  remedies.  Who 
ever  leaves  off  giving  purges  in  a  colic,  attended 
with  costiveness,  before  the  bowels  are  opened  ?  or 
who  lays  aside  mercury  as  a  useless  medicine,  be- 
cause a  few  dqses  of  it  do  not  cure  the  venereal 
disease  ? 

I  shall  only  add  under  this  head,  that  I  have 
always  observed  the  cure  of  a  malignant  fever  to  be 
most  complete,  and  the  convalescence  to  be  most 
rapid,  when  the  bleeding  has  been  continued  until 
a  paleness  is  induced  in  the  face,  and  until  the  pa- 
tient is  able  to  sit  up  without  being  fainty.  After 
these  circumstances  occur,  a  moderate  degree  of 
force  in  the  pulse  will  gradually  wear  itself  away, 
without  doings  anv  harm. 


336  DEFENCE    OF    BLOOD-LETTING. 

XIII.  In  drawing  blood,  the  quantity  should  be 
large  or  small  at  a  time,  according  to  the  state  of 
the  system.  In  cases  where  the  pulse  acts  with 
force  and  freedom,  from  10  to  20  ounces  of  blood 
may  be  taken  at  once  ;  but  in  cases  where  the  pulse 
is  much  depressed,  it  will  be  better  to  take  away 
but  a  few  ounces  at  a  time,  and  to  repeat  it  three 
or  four  times  a  day.  By  this  means  the  blood-ves- 
sels more  gradually  recover  their  vigour,  and  the 
apparent  bad  effects  of  bleeding  are  thereby  pre- 
vented. Perhaps  the  same  advantages  might  be 
derived,  in  many  other  cases,  from  the  gradual  ab- 
straction of  stimuli,  that  are  derived  from  the  gra- 
dual increase  of  their  force  and  number,  in  their 
application  to  the  body.  For  a  number  of  facts  in 
support  of  this  practice,  the  reader  is  referred  to 
the  history  of  the  yellow  fever,  in  the  year  1793. 
In  an  inflammatory  fever,  the  character  of  which  is 
not  accurately  known,  it  is  safest  to  begin  with 
moderate  bleeding,  and  to  increase  it  in  quantity, 
according  as  the  violence  and  duration  of  the  dis- 
ease shall  make  it  necessary.  In  fevers,  and  other 
diseases,  which  run  their  courses  in  a  few  days  or 
hours,  and  which  threaten  immediate  dissolution, 
there  can  be  no  limits  fixed  to  the  quantity  of  blood 
which  may  be  drawn  at  once,  or  in  a  short  time. 
Botallus  drew  three,  four,  and  five  pints  in  a  day, 


DEFENCE    OF    BLOOD-LETTING.  337 

in  such  cases.  Dr.  Jackson  drew  fifty- six  ounces 
of  blood,  at  one  time,  from  a  Mr.  Thompson,  of 
the  British  hospitals,  in  a  fever  of  great  violence 
and  danger.  This  patient  was  instantly  relieved 
from  what  he  styled  "  chains  and  horrors."  In 
three  or  four  hours  he  was  out  of  danger,  and  in 
four  days,  the  doctor  adds,  returned  to  his  duty*. 
Dr.  Physick  drew  ninety  ounces,  by  weight,  from 
Dr.  Dewees,  in  a  sudden  attack  of  the  apoplectic 
state  of  fever,  at  one  bleeding,  and  thereby  restored 
him  so  speedily  to  health,  that  he  was  able  to  at- 
tend to  his  business  in  three  days  afterwards.  In 
chronic  states  of  fever,  of  an  inflammatory  type, 
small  and  frequent  bleedings,  are  to  be  preferred  to 
large  ones.  We  use  mercury,  antimony,  and  diet 
drinks  as  alteratives  in  many  diseases  with  advan- 
tage. We  do  not  expect  to  remove  debility  by 
two  or  three  immersions  in  a  cold  bath.  We  per- 
sist with  patience  in  prescribing  all  the  above  re- 
medies for  months  and  years,  before  we  expect  to 
reap  the  full  benefits  of  them.  Why  should  not 
blood-letting  be  used  in  the  same  way,  and  have 
the  same  chance  of  doing  good?  I  have  long  ago 
adopted  this  alterative  mode  of  using  it,  and  I  can 

*  Remarks  on  the  Constitution  of  the  Medical  Depar 
ment  of  the  British  Army. 
VOL.    IV.  2   U 


338  DEFENCE    OF    BLOOD-LETTING. 

now  look  around  me,  and  with  pleasure  behold  a 
number  of  persons  of  both  sexes  who  owe  their 
lives  to  it.  In  many  cases  I  have  prescribed  it 
once  in  two  or  three  months,  for  several  years,  and 
in  some  I  have  advised  it  every  two  weeks,  for  se- 
veral months. 

There  is  a  state  of  fever  in  which  an  excess  in 
the  action  of  the  blood-vessels  is  barely  percepti- 
ble, but  which  often  threatens  immediate  danger  to 
life,  by  a  determination  of  blood  to  a  vital  part.  In 
this  case  I  have  frequently  seen  the  scale  turn  in 
favour  of  life,  by  the  loss  of  but  four  or  five  ounces 
of  blood.  The  pressure  of  this,  and  even  of  a 
much  less  quantity  of  blood  in  the  close  of  a  fever, 
I  believe,  as  effectually  destroys  life  as  the  excess 
of  several  pounds  does  in  its  beginning. 

In  cases  where  bleeding  does  not  cure,  it  may  be 
used  with  advantage  as  a  palliative  remedy.  Many 
diseases  induce  death  in  a  full  and  highly  excited 
state  of  the  system.  Here  opium  does  harm, 
while  bleeding  affords  certain  relief.  It  belongs  to 
this  remedy,  in  such  cases,  to  ease  pain,  to  pre- 
vent convulsions,  to  compose  the  mind,  to  protract 
the  use  of  reason,  to  induce  sleep,  and  thus  to 
smooth  the  passage  out  of  life. 


DEFENCE    OF    BLOOD-LETTING.  339 

XIV.  Bleeding  from  an  artery,  commonly  called 
arteriotomy,  would  probably  have  many  advantages 
over  venesection,  could  it  be  performed  at  all  times 
with  ease  and  safety.  Blood  discharged  by  haemor- 
rhages affords  more  relief,  in  fevers,  than  an  equal 
quantity  drawn  from  a  vein,  chiefly  because  it  is 
poured  forth,  in  the  former  case,  from  a  ruptured 
artery.  I  mentioned  formerly,  that  Dr.  Mitchell 
had  found  blood  drawn  from  an  artery  to  be  what 
is  called  dense,  at  a  time  when  that  which  was  drawn 
from  a  vein,  in  the  same  persons,  was  dissolved. 
This  fact  may  possibly  admit  of  some  application. 
In  the  close  of  malignant  fevers,  where  bleeding  has 
been  omitted  in  the  beginning  of  the  disease,  blood 
drawn  from  a  vein  is  generally  so  dissolved,  as  to  t?e 
beyond  the  reach  of  repeated  bleedings  to  restore  it 
to  its  natural  texture.  In  this  case,  arteriotomy 
might  probably  be  performed  with  advantage.  The 
arteries,  which  retain  their  capacity  of  life  longer 
than  the  veins,  by  being  relieved  from  the  imme- 
diate pressure  of  blood  upon  them,  might  be  ena- 
bled so  to  act  upon  the  torpid  veins,  as  to  restore 
their  natural  action,  and  thereby  to  arrest  departing 
life.  Arteriotomy  might  further  be  used  with  ad- 
vantage in  children,  in  whom  it  is  difficult,  and 
sometimes  impracticable  to  open  a  vein. 


340  DEFENCE    Of    BLOOD-LETTING. 

XV.  Much  has  been  said  about  the  proper  place 
from  whence  blood  should  be  drawn.  Bleeding  in" 
the  foot  was  much  used  formerly,  in  order  to  ex- 
cite a  revulsion  from  the  head  and  breast ;  but  our 
present  ideas  of  the  circulation  of  the  blood  have 
taught  us,  that  it  may  be  drawn  from  the  arm  with 
equal  advantage  in  nearly  all  cases.  To  bleeding  in 
the  foot  there  are  the  following  objections  :  1.  The 
difficulty  of  placing  a  patient  in  a  situation  favoura- 
ble to  it.  2.  The  greater  danger  of  wounding  a 
tendon  in  the  foot  than  in  the  arm,  And,  3.  The 
impossibility  of  examining  the  blood  after  it  is 
drawn ;  for,  in  this  mode  of  bleeding,  the  blood 
generally  flows  into  a  bason  or  pail  of  water. 

Under  this  head  I  shall  decide  upon  the  method 
of  drawing  blood  by  means  of  cups  and  leeches,  in 
the  inflammatory  state  of  fever.  Where  an  inflam- 
matory fever  arises  from  local  affection,  or  from 
contusion  in  the  head  or  breast,  or  from  a  morbid 
excitement  in  those,  above  other  parts  of  the  arte- 
rial system,  they  may  be  useful ;  but  where  local 
affection  is  a  symptom  of  general  and  equable  fe- 
ver only,  it  can  seldom  be  necessary,  except  where 
bleeding  from  the  arm  has  been  omitted,  or  used 
too  sparingly,  in  the  beginning  of  a  fever ;  by  which 
means  such  fixed  congestion  often  takes  place,  as 
will  not  yield  to  general  bleeding. 


DEFENCE    OF    BLOOD-LETTING.  341 

XVI.  Much  has  been  said  likewise  about  the 
proper  time  for  bleeding  in  fevers.  It  may  be 
used  at  all  times,  when  indicated  by  the  pulse  and 
other  circumstances,  in  continual  fevers ;  but  it 
should  be  used  chiefly  in  the  paroxysms  of  such  as 
intermit.  I  have  conceived  this  practice  to  be  of 
so  much  consequence,  that,  when  I  expect  a  return 
of  the  fever  in  the  night,  I  request  one  of  my  pu- 
pils to  sit  up  with  my  patients  all  night,  in  order  to 
meet  the  paroxysm,  if  necessary,  with  the  lancet. 
But  I  derive  another  advantage  from  fixing  a  centi- 
nel  over  a  patient  in  a  malignant  fever.  When  a 
paroxysm  goes  off  in  the  night,  it  often  leaves  the 
system  in  a  state  of  such  extreme  debility,  as  to 
endanger  life.  In  this  case,  from  five  to  ten  dr<5ps 
of  laudanum,  exhibited  by  a  person  who  is  a  judge 
of  the  pulse,  obviate  this  alarming  debility,  and 
often  induce  easy  and  refreshing  sleep.  By  treat- 
ing the  human  body  like  a  corded  instrument,  in 
thus  occasionally  relaxing  or  bracing  the  system, 
according  to  the  excess  or  deficiency  of  stimulus, 
in  those  hours  in  which  death  most  frequently  oc- 
curs, I  think  I  have  been  the  -means  of  saving  seve- 
ral valuable  lives. 

XVII.  The  different  positions  of  the  body  influ- 
ence the  greater  or  less  degrees  of  relief  which  are 
obtained  by  blood-letting.     Where  there  is  a  great 


342  DEFENCE    OF    BLOOD-LETTING. 

disposition  to  syncope,  and  where  it  is  attended 
with  alarming  and  distressing  circumstances,  blood 
should  be  drawn  in  a  recumbent  posture,  but 
where  there  is  no  apprehension  or  dread  of  faint- 
ing, it  may  be  taken  in  a  sitting  posture.  The  re- 
lief will  be  more  certain  if  the  patient  be  able  to 
stand  while  he  is  bled.  A  small  quantity  of  blood, 
drawn  in  this  posture,  brings  on  fainting,  and  the 
good  effects  which  are  often  derived  from  it.  It 
should  therefore  be  preferred,  where  patients  ob- 
ject to  copious  or  frequent  bleedings.  The  history 
of  the  success  of  this  practice  in  the  British  army, 
recently  mentioned  from  Dr.  Sydenham,  furnishes 
a  strong  argument  in  its  favour. 

I  regret  that  the  limits  I  have  fixed  to  this  De- 
fence of  Blood-letting  will  not  admit  of  my  apply- 
ing the  principles  which  have  been  delivered,  to 
all  the  inflammatory  states  of  fever.  In  a  future 
essay,  I  hope  to  establish  its  efficacy  in  the  ma- 
naical  state  of  fever.  I  have  said  that  madness  is 
the  effect  of  a  chronic  inflammation  in  the  brain. 
Its  remedy,  of  course,  should  be  frequent  and  co- 
pious blood-letting.  Physical  and  moral  evil  are 
subject  to  similar  laws.  The  mad-shirt,  and  all 
the  common  means  of  coercion,  are  as  improper 
substitutes  for  bleeding,  in  madness,  as  the  whip- 
ping-post and  pillory  are  for  solitary  confinement 


DEFENCE    OF    BLOOD-LETTING.  343 

and  labour,  in  the  cure  of  vice.  The  pulse  should 
govern  the  use  of  the  lancet  in  this,  as  well  as  in  all 
the  ordinary  states  of  fever.  It  is  the  dial- plate  of 
the  system.  But  in  the  misplaced  states  of  fever, 
the  pulse,  like  folly  in  old  age,  often  points  at  a 
different  mark  from  nature.  In  all  such  cases,  we 
must  conform  our  practice  to  that  which  has  been 
successful  in  the  reigning  epidemic.  A  single 
bleeding,  when  indicated  by  this  circumstance,  of- 
ten converts  a  fever  from  a  suffocated,  or  latent,  to 
a  sensible  state,  and  thus  renders  it  a  more  simple 
and  manageable  disease. 

It  is  worthy  of  consideration  here,  how  far  local 
diseases,  which  have  been  produced  by  fevers, 
might  be  cured  by  re-exciting  the  fever.  Sir 
William  Jones  says,  the  physicians  in  Persia  always 
begin ^the  cure  of  the  leprosy  by  blood-letting*. 
Possibly  this  remedy  diffuses  the  disease  through 
the  blood-vessels,  and  thereby  exposes  it  to  be 
more  easily  acted  upon  by  other  remedies. 

Having  mentioned  the  states  of  fever  in  which 
blood-letting  is  indicated,  and  the  manner  in  which 
it  should  be  performed,  I  shall  conclude  this  in- 
quiry by  pointing  out  the  states  of  fever  in  which 

*  Asiatic  Essays* 


344  DEFENCE    OF    BLOOD-LETTING. 

it  is  forbidden,  or  in  which  it  should  be  cautiously 
or  sparingly  performed.  This  subject  is  of  con- 
sequence, and  should  be  carefully  attended  to  by  all 
who  wish  well  to  the  usefulness  and  credit  of  the 
lancet. 

1.  It  is  forbidden  in  that  state  of  fever,  as  well 
as  in  other  diseases,  in  which  there  is  reason  to  be- 
lieve the  brain  or  viscera  are  engorged  with  blood, 
and  the  whole  system  prostrated  below  the  point  of 
re- action.  I  have  suggested  this  caution  in  ano- 
ther place*.  The  pulse  in  these  cases  is  feeble, 
and  sometimes  scarcely  perceptible,  occasioned  by 
the  quantity  of  blood  in  the  blood-vessels  being 
reduced,  in  consequence  of  the  stagnation  of  large 
portions  of  it  in  the  viscera.  By  bleeding  in  these 
cases,  we  deprive  the  blood-vessels  of  the  feeble 
remains  of  the  stimulus  which  keep  up  their  ac- 
tion, and  thus  precipitate  death.  The  remedies 
here  should  be  frictions,  and  stimulating  applica- 
tions to  the  extremities,  and  gentle  stimuli  taken 
by  the  mouth,  or  injected  into  the  bowels.  As 
soon  as  the  system  is  a  little  excited  by  these  reme- 
dies, blood  may  be  drawn,  but  in  small  quantities 
at  a  time,  and  perhaps  only  by  means  of  cups  or 
leaches  applied  ta  the  seats  of  the  congestions  of 

*  Vol.  iiu 


DEFENCE    OF    BLOOD-LETTING.  345 

the  blood.  After  the  vessels  are  excited  by  the 
equable  diffusion  of  the  blood  through  all  their 
parts,  it  may  with  safety  be  drawn  from  the  arm, 
provided  it  be  indicated  by  the  pulse. 

2.  It  is  seldom  proper  beyond  the  third  day,  in 
a  malignant  fever,  if  it  has  not  been  used  on  the 
days  previous  to  it,  and  for  the  same  reason  that 
has  been  given  under  the  former  head.  Even  the 
tension  of  the  pulse  is  not  always  a  sufficient  war- 
rant to  bleed,  for  in  three  days,  in  a  fever  which 
runs  its  course  in  five  days,  the  disorganization  of 
the  viscera  is  so  complete,  that  a  recovery  is  scarce- 
ly to  be  expected  from  the  lancet.  The  remedies 
which  give  the  only  chance  of  relief  in  this  case, 
are  purges,  blisters,  and  a  salivation.  * 

3.  Where  fevers  are  attended  with  paroxysms, 
bleeding  should  be  omitted,  or  used  with  great 
caution,  in  the  close  of  those  paroxysms.  The 
debility  which  accompanies  the  intermission  of 
the  fever  is  often  so  much  increased  by  the  recent 
loss  of  blood,  as  sometimes  to  endanger  life. 

4.  Bleeding  is  forbidden,  or  should  be  used 
cautiously  in  that  malignant  state  of  fever,  in  which 
a  weak  morbid  action,  or  what  Dr.  Darwin  calls 
a  tendency  to  inirritability,  takes  place  in  the  bloods 

vol.  iv.  2  x 


346  DEFENCE    OF    BLOOD-LETTING. 

vessels.  It  is  known  by  a  weak  and  frequent 
pulse,  such  as  occurs  in  the  typhus  fever,  and  in 
the  plague  in  warm  climates.  I  have  often  met 
with  it  in  the  malignant  sore  throat,  and  occasion- 
ally in  the  pleurisy  and  yellow  fever.  The  reme- 
dies here  should  be  gentle  vomits  or  purges,  and 
afterwards  cordials.  Should  the  pulse  be  too  much 
excited  by  them,  bleeding  may  be  used  to  reduce 
it. 

5 .  It  should  be  used  sparingly  in  the  diseases  of 
habitual  drunkards.  The  morbid  action  in  such 
persons,  though  often  violent,  is  generally  transient. 
It  may  be  compared  to  a  soap-bubble.  The  arte- 
ries, by  being  often  overstretched  by  the  stimulus 
of  strong  drink,  do  not  always  contract  with  the  di- 
minution of  blood,  and  such  patients  often  sink, 
from  this  cause,  from  the  excessive  use  of  the  lan- 
cet. 

6.  It  has  been  forbidden  after  the  suppurative 
process  has  begun  in  local  inflammation.  It  con- 
stantly retards  the  suppuration,  when  begun,  in 
the  angina  tonsillaris,  and  thus  protracts  that  dis- 
ease.    To  this  rule  there  are  frequent  exceptions. 

7.  It  should  be  omitted  in  pneumony,  after  co- 
pious expectoration  has  taken  place.       This  dis- 


DEFENCE    OF    BLOOD-LETTING.  347 

charge  is  local  depletion,  and,  though  slow  in  its 
effects  compared  with  bleeding,  it  serves  the  same 
purpose  in  relieving  the  lungs.  The  lancet  can 
only  be  required  where  great  pain  in  coughing, 
and  a  tense  pulse,  attend  this  stage  of  the  disease. 

8.  It  may  be  omitted  (except  when  the  blood- 
vessels are  insulated)  in  those  diseases  in  which 
there  is  time  to  wait,  without  danger  to  life,  or  fu- 
ture health,  for  the  circuitous  operation  of  purging 
medicines,  or  abstemious  diet. 

9.  It  should  be  avoided,  when  it  can  be  done 
without  great  danger  to  life,  where  there  is  a 
great  and  constitutional  dread  of  the  operation.  In 
such  cases,  it  has  sometimes  done  harm  to  the  pa- 
tient, and  injured  the  credit  of  the  lancet. 

10.  There  are  cases  in  which  sizy  blood  should 
not  warrant  a  repetition  of  blood-letting.  Mr. 
White  informs  us,  in  the  History  of  the  Bilious 
Fever  which  has  lately  prevailed  at  Bath,  that  bleed- 
ing, in  many  cases  in  which  this  appearance  of  the 
blood  took  place,  was  useless  or  hurtful.  In  some 
of  the  fevers  of  our  own  country,  we  sometimes  see 
sizy  blood  followed  by  symptoms  which  forbid  the 
repeated  use  of  the  lancet,  but  which  yield  to  other 
depleting  remedies,  or  to  such  as  are  of  a  cordial 


348  DEFENCE    OF    BLOOD-LETTING. 

nature.  I  have  seen  the  same  kind  of  blood,  a 
few  hours  before  death,  in  a  pulmonary  consump- 
tion, and  three  days  after  a  discharge  of  a  gallon 
and  a  half  of  blood  from  the  stomach  by  vomiting. 

11.  Even  a  tense  pulse  does  not  always  call  for 
the  repeated  use  of  the  lancet.  I  have  mentioned 
one  case,  viz.  on  the  third  or  fourth  days  of  a  ma- 
lignant fever,  in  which  it  is  improper.  There  are 
instances  of  incurable  consumptions  from  tubercles 
and  ulcers  in  the  lungs,  in  which  the  pulse  cannot 
be  made  to  feel  the  least  diminution  of  tension  by 
either  copious  or  frequent  bleedings.  There  are 
likewise  cases  of  hepatic  fever,  in  which  the  pulse 
cannot  be  subdued  by  this  remedy.  This  tense 
state  of  the  pulse  is  the  effect  of  a  suppurative  pro- 
cess in  the  liver.  If  a  sufficient  quantity  of  blood 
has  been  drawn  in  the  first  stage  of  this  disease, 
there  is  little  danger  from  leaving  the  pulse  to  re- 
duce or  wear  itself  down  by  a  sudden  or  gradual 
discharge  of  the  hepatic  congestion.  The  recove- 
ry in  this  case  is  slow,  but  it  is  for  the  most  part 
certain.  I  have  once  known  a  dropsy  and  death 
induced  by  the  contrary  practice. 

12.  and  lastly.  There  is  sometimes  a  tension  in 
the  pulse  in  haemorrhages,  that  will  not  yield  to 
the  lancet.     The  man  whose  blood  was  sizy,  three 


DEFENCE    OF    BLOOD-LETTING.  349 

days  after  losing  a  gallon  and  a  half  of  it  from  his 
stomach,  had  a  tense  pulse  the  day  before  he  died; 
and  I  once  perceived  its  last  strokes  to  be  tense,  in 
a  patient  whom  I  lost  in  a  yellow  fever  by  a  hae- 
morrhage from  the  nose.  The  only  circumstance 
that  can  justify  bleeding  in  these  cases  is  ex- 
treme pain,  in  which  case,  the  loss  of  a  few  ounces 
of  blood  is  a  more  safe  and  effectual  remedy  than 
opium. 

I  shall  now  add  a  few  remarks  upon  the  efficacy 
of  blood-letting,  in  diseases  which  are  not  supposed 
to  belong  to  the  class  of  fevers,  and  which  have 
not  been  included  in  the  preceding  volumes. 

I.  The  philosophers,  in  describing  the  humble 
origin  of  man,  say  that  he  is  formed  "  inter  stercus 
et  urinam."  The  divines  say  that  he  is  "  con- 
ceived in  sin,  and  shapen  in  iniquity."  I  believe  it 
to  be  equally  true,  and  alike  humiliating,  that  he  is 
conceived  and  brought  forth  in  disease. 

This  disease  appears  in  pregnancy  and  parturi- 
tion. I  shall  first  endeavour  to  prove  this  to  be 
the  case,  and  afterwards  mention  the  benefits  of 
blood-letting  in  relieving  it,  in  both  cases. 


350  DEFENCE    OF    BLOOD-LETTING. 

In  pregnancy,  the  uterus  is  always  affected  with 
that  grade  of  morbid  action  which  I  formerly  call- 
ed inflammation.  This  is  evident  from  its  exhibit- 
ing all  its  usual  phenomena  in  other  parts  of  the 
bodv.     These  are, 

1.  Swelling,  or  enlargement. 

2.  Haemorrhage.  The  lochia  are  nothing  but 
a  slow  and  spontaneous  bleeding  performed  by  na- 
ture, and  intended  to  cure  the  inflammation  of  the 
uterus  after  parturition. 

3.  Abscesses,  schirri,  and  cancers.  It  is  true, 
those  disorders  sometimes  occur  in  women  that 
have  never  borne  children.  In  these  cases,  they 
are  the  effects  of  the  inflammation  excited  by  the 
menstrual  disease. 

4.  A  full,  quick,  and  tense  or  frequent  pulse ; 
pain  ;  want  of  appetite* ;  sickness  at  stomach  ; 
puking ;  syncope  ;  and  sometimes  convulsions  in 
every  part  of  the  body. 

*  Dr.  Hunter  used  to  teach,  in  his  lectures,  that  the 
final  cause  of  the  want  of  appetite,  during  the  first  months 
of  pregnancy,  was  to  obviate  plethora,  which  disposed  to 
abortion.  This  plethora  should  have  been  called  an  inflam- 
matory disease,  in  which  abstinence  is  useful. 


DEFENCE    OF    BLOOD-LETTING.  351 

5.  Sizy  blood.     This  occurs  almost  uniformly 
in  pregnancy. 

6.  A  membrane.  Dr.  Scarpa  has  proved  the 
membrana  decidua,  which  is  formed  during  preg- 
nancy, to  be  in  every  respect  the  same  in  its  pro- 
perties with  the  membrane  which  is  formed  upon 
other  inflamed  surfaces,  particularly  the  trachea, 
the  pleura,  and  the  inside  of  the  bowels.  Thus  we 
see  all  the  common  and  most  characteristic  symp- 
toms and  effects  of  inflammation,  in  other  parts  of 
the  body,  are  exhibited  by  the  uterus  in  pregnancy. 

These  remarks  being  premised,  I  proceed  to  re- 
mark, that  blood-letting  is  indicated,  in  certain 
states  of  pregnancy,  by  all  the  arguments  that  have 
been  used  in  favour  of  it  in  any  other  inflammatory 
disease.  The  degree  of  inflammation  in  the  womb, 
manifested  by  the  pulse,  pain,  and  other  signs  of 
disease,  should  determine  the  quantity  of  blood  to 
be  drawn.  Low  diet,  gentle  purges,  and  constant 
exercise,  are  excellent  substitutes  for  it,  but  where 
they  are  not  submitted  to,  blood-letting  should  be 
employed  as  a  substitute  for  them.  In  that  dispo- 
sition to  abortion,  which  occurs  about  the  third 
month  of  pregnancy,  small  and  frequent  bleedings 
should  be  preferred  to  all  other  modes  of  depletion. 
I  can  assert,   from  experience,  that  they  prevent 


352  DEFENCE    OF    BLOOD-LETTING. 

abortion,  nearly  with  as  much  certainty  as  they  pre- 
vent a  haemorrhage  from  the  lungs  :  for  what  is  an 
abortion  but  a  haemoptysis  (if  I  may  be  allowed  the 
expression)  from  the  uterus?  During  the  last 
month  of  pregnancy,  the  loss  of  from  twelve  to 
twenty  ounces  of  blood  has  the  most  beneficial  ef- 
fects, in  lessening  the  pains  and  danger  of  child- 
birth, and  in  preventing  its  subsequent  diseases. 

The  doctrine  I  have  aimed  to  establish  leads,  not 
only  to  the  use  of  blood-letting  in  the  disease  of 
pregnancy,  when  required,  but  to  a  more  copious 
use  of  it,  when  combined  with  other  diseases,  than 
in  those  diseases  in  a  simple  state.  This  remark 
applies,  in  a  particular  manner,  to  those  spasms  and 
convulsions  which  sometimes  occur  in  the  latter 
months  of  pregnancy,  Without  bleeding,  they 
are  always  fatal.  By  copious  bleeding,  amounting 
in  some  instances  to  80  and  100  ounces,  they  are 
generally  cured. 

Let  it  not  be  supposed  that  blood-letting  is  alike 
proper  and  useful  in  every  state  of  pregnancy. 
There  are  what  are  called  slow  or  chronic  inflam- 
mations, in  which  the  diseased  action  of  the  blood- 
vessels not  only  forbids  it,  but  calls  for  cordial  and 
stimulating:  remedies.  The  same  feeble  state  of 
inflammation  sometimes  takes  place  in  the  preg- 


DEFENCE    OF    BLOOD-LETTING.  353 

nant  uterus.    In  these  cases  cordials  and  stimulants 
should  be  preferred  to  the  lancet. 

Parturition  is  a  higher  grade  of  disease  than  that 
which  takes  place  in  pregnancy.      It  consists  of 
convulsive  or  clonic  spasms  in  the  uterus,  super- 
vening its  inflammation,  and  is  accompanied  with 
chills,  heat,  thirst,  a  quick,  full,  tense,  or  a  frequent 
and  depressed  pulse,  and  great  pain.      By  some 
divines   these   symptoms,    and   particularly  pain, 
have  been  considered  as  a  standing  and  unchange- 
able punishment  of  the  original  disobedience  of 
woman,  and,  by  some  physicians,  as  indispensa- 
bly necessary  to  enable  the  uterus  to  relieve  itself 
of  its  burden.      By  contemplating  the  numerous 
instances  in  which  it  has  pleased  God  to  bless  the 
labours  and  ingenuity  of  man,  in  lessening  or  des- 
troying the  effects  of  the  curse  inflicting  upon  the 
earth,  and  by  attending  to  the  histories  of  the  total 
exemption  from  pain  in  child-bearing  that  are  re- 
corded of  the  women  in  the  Brasils,  Calabria,  and 
some  parts  of  Africa,  and  of  the  small  degrees  of  it 
which  are  felt  by  the  Turkish  women,  who  reduce 
their  systems  by  frequent  purges  of  sweet  oil  dur- 
ing pregnancy,  I  was  induced  to  believe  pain  does 
not  accompany  child-bearing  by  an  immutable  de- 
cree of  Heaven.       By  recollecting   further  how 
effectually  biqpd-letting  relieves  many  other  spas- 

vol.   iv.  2-  Y 


354  DEFENCE    OF    BLOOD-LETTINGS 

fnodic  and  painful  diseases,  and  how  suddenly  it 
relaxes  rigidity  in  the  muscles,  I  was  led,  in  the 
year  1795,  to  suppose  it  might  be  equally  effectual 
in  lessening  the  violence  of  the  disease  and  pains 
of  parturition.  I  was  encouraged  still  more  to  ex- 
pect this  advantage  from  it,  by  having  repeated- 
ly observed  the  advantages  of  copious  bleeding 
for  inflammatory  fevers,  just  before  delivery,  in 
mitigating  its  pains,  and  shortening  its  duration. 
Upon  my  mentioning  these  reflections  and  facts  to 
Dr.  Dewees,  I  was  much  gratified  in  being  in- 
formed, that  he  had  been  in  the  practice,  for  seve- 
ral years  before  his  removal  from  Abingdon  to 
Philadelphia,  of  drawing  large  quantities  of  blood 
during  parturition,  and  with  all  the  happy  effects 
I  had  expected  from  it.  The  practice  has  been 
strongly  inculcated  by  the  doctor  in  his  lectures 
upon  midwifery,  and  has  been  ably  defended  and 
supported  by  a  number  of  recent  facts,  in  an  inge- 
nious inaugural  dissertation,  published  by  Dr.  Pe- 
ter Miller,  in  the  year  1804.  It  has  been  generally 
adopted  by  the  practitidners  of  midwifery,  of  both 
sexes,  in  Philadelphia. 

I  do  not  mean  to  insinuate  that  bleeding  is  a  new 
remedy  in  parturition.  It  has  long  ago  been  ad- 
vised and  used  in  France,  and  even  by  the  mid- 
wives  of  Genoa,  in  Italy,  but  never,  in  any  country, 


DEFENCE    OP    BLOOD-LETTING.  355 

in  the  large  quantities  that  have  been  recommended 
by  Dr.  Dewees,  that  is,  from  20  to  80  ounces,  or 
until  signs  of  fainting  are  induced,  nor  under  the 
influence  of  the  theory  of  parturition,  being  a  vio- 
lent disease. 

But  the  advantages  of  this  remedy  are  not  con- 
fined to  lessening  the  pains  of  delivery.  It  pre- 
vents after  pains ;  favours  the  easy  and  healthy  se- 
cretion of  milk  ;  prevents  sore  breasts,  swelled  legs, 
puerperile  fever,  and  all  the  distressing  train  of 
anomalous  complaints  that  often  follow  child-bear- 
ing. Dr.  Hunter  informed  his  pupils,  in  his  lec- 
tures upon  midwifery,  in  the  year  1769,  that  he 
had  often  observed  the  most  rapid  recoveries  to 
succeed  the  most  severe  labours.  The  severity 
of  the  pains  in  these  cases  created  a  disease,  which 
prevented  internal  congestions  in  the  womb. 
Bleeding,  by  depleting  the  uterus,  obviates  at  once 
both  disease  and  congestion.  Its  efficacy  is  much 
aided  by  means  of  glysters,  which,  by  emptying 
the  lower  bowels,  lessen  the  pressure  upon  the 
uterus. 

Let  it  not  be  inferred,  from  what  has  been  said  in 
favour  of  blood-letting  in  parturition,  that  it  is  pro- 
per in  all  cases.  Where  there  has  been  great  previ- 
ous inanition,  and  where  there  are  marks  of  languor, 


'  1 


356  DEFENCE    OF    BLOOD-LETTING. 

and  feeble  morbid  action  in  the  system,  the  reme- 
dies should  be  of  an  opposite  nature.  Opium  and 
other  cordials  are  indicated  in  these  cases.  Their 
salutary  effects  in  exciting  the  action  of  the  uterus, 
and  expediting  delivery,  are  too  well  known  to  be 
mentioned. 

I  have  expressed  a  hope  in  another  place*,  that 
a  medicine  would  be  discovered  that  should  sus- 
pend sensibility  altogether,  and  leave  irritability,  or 
the  powers  of  motion,  unimpaired,  and  thereby 
destroy  labour  pains  altogether.  I  was  encouraged 
to  cherish  this  hope,  by  having  known  delivery  to 
take  place,  in  one  instance,  during  a  paroxysm  of 
epilepsy,  and  having  heard  of  another,  during  a  fit 
of  drunkenness,  in  a  woman  attended  by  Dr. 
Church,  in  both  of  which  there  was  neither  consci- 
ousness, nor  recollection  of  pain. 

2.  During  the  period  in  which  the  menses  are 
said  to  dodge,  and  for  a  year  or  two  after  they  cease 
to  flow,  there  is  a  morbid  fulness  and  excitement 
in  the  blood-vessels,  which  are  often  followed  by 
head-ach,  cough,  dropsy,  haemorrhages,  glandular 
obstructions,  and  cancers.  They  may  all  be  pre- 
vented by  frequent  and  moderate  bleedings. 

9  Medical  Repository,  vol.  vi. 


DEFENCE    OF    BLOOD-LETTING.  357 

3.  It  has  been  proved,  by  many  facts,  that  opium, 
when  taken  in  an  excessive  dose,  acts  by  inducing 
a  similar  state  of  the  system  with  that  which  is 
induced  by  the  miasmata  which  bring  on  malignant 
and  inflammatory  fevers.  The  remedy  for  the  dis- 
ease produced  by  it  (where  a  vomiting  cannot  be 
excited  to  discharge  the  opium)  has  been  found  to 
be  copious  blood-  letting.  Of  its  efficacy,  the  reader 
will  find  an  account  in  four  cases,  published  in  the 
fifth  volume  of  the  New- York  Medical  Repository. 

4.  It  is  probable,  from  the  uniformly  stimulating 
manner  in  which  poisons  of  all  kinds  act  upon  the 
human  body,  that  bleeding  would  be  useful  in  ob- 
viating their  baneful  effects.  Dr.  John  Dorsey  has 
lately  proved  its  efficacy,  in  the  case  of  a  child  that 
was  affected  with  convulsions,  in  consequence  of 
eating  the  leaves  of  the  datura  stramonium. 

5.  It  has  been  the  misfortune  of  diabetes  to  be 
considered  by  physicians  as  exclusively  a  local  dis- 
ease of  weak  morbid  action,  or  as  the  effect  of  sim- 
ple debility  in  the  kidneys ;  and  hence  stimulating 
and  tonic  medicines  have  been  exclusively  pre- 
scribed for  it.  This  opinion  is  not  a  correct  one. 
It  often  affects  the  whole  arterial  system,  more  es- 
pecially in  its  first  stage,  with  great  morbid  action. 
In  two  cases  of  it,  where  this  state  of  the  blood- 


358  DEFENCE    OF    BLOOD-LETTING. 

vessels  took  place,  I  have  used  blood-letting  with 
success,  joined  with  the  common  remedies  for  in- 
flammatory diseases. 

6.  In  dislocated  bones  which  resist  both  skill 
and  force,  it  has  been  suggested,  that  bleeding, 
till  fainting  is  induced,  would  probably  induce 
such  a  relaxation  in  the  muscles  as  to  favour 
their  reduction.  This  principle  was  happily  ap- 
plied, in  the  winter  of  1795,  by  Dr.  Physick,  in 
the  Pennsylvania  hospital,  in  a  case  of  dislocated 
humerus  of  two  months  continuance.  The  doc- 
tor bled  his  patient  till  he  fainted,  and  then  reduced 
his  shoulder  in  less  than  a  minute,  and  with  very 
little  exertion  of  force.  The  practice  has  since  be- 
come general  in  Philadelphia,  in  luxations  of  large 
bones,  where  they  resist  the  common  degrees  of 
strength  employed  to  reduce  them. 

In  contemplating  the  prejudices  against  blood- 
letting, which  formerly  prevailed  so  generally  in 
our  countrv,  I  have  been  led  to  ascribe  them  to  a 

ml      ' 

cause  wholly  political.  We  are  descended  chiefly 
from  Great- Britain,  and  have  been  for  many  years 
under  the  influence  of  English  habits  upon  all  sub- 
jects. Some  of  these  habits,  as  far  as  they  relate 
to  government,  have  been  partly  changed;  but  in 
dress,  arts,  manufactures,  manners,  and  science, 


DEFENCE    OF    BLOOD-LETTING.  359 

we  are  still  governed  by  our  early  associations. 
Britain  and  France  have  been,  for  many  centuries, 
hereditary  enemies.  The  hostility  of  the  former  to 
the  latter  nation,  extends  to  every  thing  that  be- 
longs to  their  character.  It  discovers  itself,  in  an 
eminent  degree,  in  diet  and  medicine.  Do  the 
French  love  soups  ?  the  English  prefer  solid  flesh. 
Do  the  French  love  their  meats  well  cooked  ?  the 
English  prefer  their  meats  but  half  roasted.  Do 
the  French  sip  coffee  after  dinner?  the  English 
spend  their  afternoons  in  drinking  Port  and  Ma- 
deira wines.  Do  the  French  physicians  prescribe 
purges  and  glysters  to  cleanse  the  bowels?  the  Eng- 
lish physicians  prescribe  vomits  for  the  same  pur- 
pose. Above  all,  do  the  French  physicians  advise 
bleeding  in  fevers  ?  the  English  physicians  forbid 
it,  in  most  fevers,  and  substitute  sweating  in  the 
room  of  it.  Here  then  we  discover  the  source  of 
the  former  prejudices  and  errors  of  our  country- 
men, upon  the  subject  of  blood-letting.  They  are 
of  British  origin.  They  have  been  inculcated 
in  British  universities,  and  in  British  books;  and 
they  accord  as  ill  with  our  climate  and  state  of 
society,  as  the  Dutch  foot  stoves  did  with  the  tem- 
perate climate  of  the  Cape  of  Good  Hope*. 

*   I  have  frequently  been  surprised,  in  visiting  English 
patients,  to  hear  them  say,  when  I  have  prescribed  bleeding, 


360  DEFENCE    OF    BLOOD-LETTING. 

It  is  probable  the  bad  consequences  which  have 
followed  the  indiscriminate  use  of  the  lancet  in 
France,  and  some  other  countries,  may  have  con- 
tributed in  some  degree  to  create  the  prejudices 
against  it,  which  are  entertained  by  the  physicians 
in  Great-Britain.  Bleeding,  like  opium,  has  lost 
its  character,  in  many  cases,  by  being  prescribed 
for  the  name  of  a  disease.  It  is  still  used,  Mr. 
Townsend  tells  us,  in  this  empirical  way  in  Spain, 
where  a  physician,  when  sent  for  to  a  patient,  or- 
ders him  to  be  bled  before  he  visits  him.  The 
late  just  theory  of  the  manner  in  which  opium  acts 
upon  the  body,  has  restrained  its  mischief,  and  add- 
ed greatly  to  its  usefulness.     In  like  manner,  may 

that  their  physicians  in  England  had  charged  them  never  to 
be  bled.  This  advice  excluded  all  regard  to  the  changes 
which  climate,  diet,  new  employments,  and  age  might  in- 
duce upon  the  system.  I  am  disposed  to  believe  that  many 
lives  are  lost,  and  numerous  chronic  diseases  created  in 
Great-Britain,  by  the  neglect  of  bleeding  in  fevers.  My  for- 
mer pupil,  Dr.  Fisher,  in  a  letter  from  the  university  of 
Edinburgh,  dated  in  the  winter  of  1795,  assured  me,  that  he 
had  cured  several  of  his  fellow-students  of  fevers  (contrary 
to  general  prejudice)  by  early  bleeding,  in  as  easy  and  sum- 
mary a  way  as  he  had  been  accustomed  to  see  them  cured 
in  Philadelphia,  by  the  use  of  the  same  remedy.  Dr.  Gor- 
don, of  Scotland,  and  several  other  physicians  in  Great-Bri- 
tain, have  lately  revived  the  lancet,  and  applied  it  with  great 
judgment  and  success  to  the  cure  of  fevers. 


DEFENCE    OF    BLOOD-LETTING.  361 

we  not  hope,  that  just  theories  of  diseases,  and 
proper  ideas  of  the  manner  in  which  bleeding  acts 
in  curing  them,  will  prevent  a  relapse  into  the  evils 
which  formerly  accompanied  this  remedy,  and  ren- 
der it  a  great  and  universal  blessing  to  mankind  2 


Vol.  rv.  2  z 


AN  INQUIRY 


INTO    THE 


Comparative  State  of  Medicine, 


IN  PHILADELPHIA, 


BETWEEN    THE    YEARS    1760   AND    1766, 


AND    THE    YEAR     1805. 


AN  INQUIRY,  &c. 


IN  estimating  the  progress  and  utility  of 
medicine,  important  advantages  may  be  derived 
from  taking  a  view  of  its  ancient,  and  comparing 
it  with  its  present  state.  To  do  this  upon  an  ex- 
tensive scale,  would  be  difficult,  and  foreign  to  the 
design  of  this  inquiry.  I  shall  therefore  limit  it,  to 
the  history  of  the  diseases  and  medical  opinions 
which  prevailed,  and  of  the  remedies  which  were 
in  use,  in  the  city  of  Philadelphia,  between  the 
years  1760  and  1766,  and  of  the  diseases,  medi- 
cal opinions,  and  remedies  of  the  year  1805.  The 
result  of  a  comparative  view  of  each  of  them,  will 
determine  whether  medicine  has  declined  or  im- 
proved, in  that  interval  of  time,  in  this  part  of  the 
world. 

To  derive  all  the  benefits  that  are  possible  from 
such  an  inquiry,  it  will  be  proper  to  detail  the 


366  STATE    OF    MEDrciNE, 

causes,  which,  by  acting  upon  the  human  body, 
influence  the  subjects  that  have  been  mentioned, 
in  those  two  remote  periods  of  time. 

Those  causes  divide  themselves  into  climate, 
diet,  dress,  and  certain  peculiar  customs ;  on  each 
of  which  I  shall  make  a  few  remarks. 

After  what  has  been  said,  in  the  history  of  the 
Climate  of  Pennsylvania,  in  the  first  volume  of  these 
Inquiries,  it  will  only  be  necessary  in  this  place 
briefly  to  mention,  that  the  winters  in  Philadelphia, 
between  the  years  1760  and  1766,  were  almost  uni- 
formly cold.  The  ground  was  generally  covered 
with  snow,  and  the  Delaware  frozen,  from  the  first 
or  second  week  in  December,  to  the  last  week  in 
February,  or  the  first  week  In  March,  Thaws 
were  rare  during  the  winter  months,  and  seldom  of 
longer  duration  than  three  or  four  days.  The 
springs  began  in  May.  The  summers  were  gene- 
rally warm,  and  the  air  seldom  refreshed  by  cool 
north-west  winds.  Rains  were  frequent  and  heavy, 
and  for  the  most  part  accompanied  with  thunder  and 
lightning.  The  autumns  began  in  October,  and 
were  gradually  succeeded  by  cool  and  cold  weather. 

The  diet  of  the  inhabitants  of  Philadelphia,  dur- 
ing those  years,  consisted  chiefly  of  animal  food. 


BETWEEN   1760  AND   1766,  AND   1805.     367 

It  was  eaten,  in  some  families,  three  times,  and  in 
all,  twice  a  day.  A  hot  supper  was  a  general  meal. 
To  two  and  three  meals  of  animal  food  in  a  day, 
many  persons  added  what  was  then  called  "  a  re- 
lish," about  an  hour  before  dinner.  It  consisted  of 
a  slice  of  ham,  a  piece  of  salted  fish,  and  now  and 
then  a  beef- steak,  accompanied  with  large  draughts 
of  punch  or  toddy.  Tea  was  taken  in  the  interval 
between  dinner  and  supper. 

In  many  companies,  a  glass  of  wine  and  bitters 
was  taken  a  few  minutes  before  dinner,  in  order  to 
increase  the  appetite. 

The  drinks,  with  dinner  and  supper,  were  punch 
and  table  beer. 

Besides  feeding  thus  plentifully  in  their  families, 
many  of  the  most  respectable  citizens  belonged  to 
clubs,  which  met  in  the  city  in  winter,  and  in  its 
vicinity,  under  sheds,  or  the  shade  of  trees,  in 
summer,  once  and  twice  a  week,  and,  in  one  in- 
stance, every  night.  They  were  drawn  together 
by  suppers  in  winter,  and  dinners  in  summer. 
Their  food  was  simple,  and  taken  chiefly  in  a  solid 
form.  The  liquors  used  with  it  were  punch,  Lon- 
don porter,  and  sound  old  Madeira  wine. 


368  STATE    OF    MEDICINE, 

Independently  of  these  clubs,  there  were  occa- 
sional meetings  of  citizens,  particularly  of  young 
men,  at  taverns,  for  convivial  purposes.  A  house 
in  Water- street,  known  by  the  name  of  the  Tun 
tavern,  was  devoted  chiefly  to  this  kind  of  acci- 
dental meetings.  They  were  often  followed  by 
midnight  sallies  into  the  streets,  and  such  acts  of 
violence  and  indecency,  as  frequently  consigned 
the  perpetrators  of  them  afterwards  into  the  hands 
of  the  civil  officers  and  physicians  of  the  city. 

Many  citizens,  particularly  tradesmen,  met  every 
evening  for  the  purpose  of  drinking  beer,  at  houses 
kept  for  that  purpose.  Instances  of  drunkenness 
were  rare  at  such  places.  The  company  generally 
parted  at  ten  o'clock,  and  retired  in  an  orderly 
manner  to  their  habitations.  Morning  drams, 
consisting  of  cordials  of  different  kinds,  were  com- 
mon, both  in  taverns  and  private  houses,  but  they 
were  confined  chiefly  to  the  lower  class  of  people. 

From  this  general  use  of  distilled  and  fermented 
liquors,  drunkenness  was  a  common  vice  in  all  the 
different  ranks  of  society. 

The  dresses  of  the  men,  in  the  years  alluded  to, 
were  composed  of  cloth  in  winter,  and  of  thin 
woollen  or  silk  stuffs  in  summer.    Wigs  composed 


BETWEEN   1760  AND   1766,  AND   1805.    369 

the  covering  of  the  head,  after  middle  life,  and 
cocked  hats  were  universally  worn,  except  by  the 
men  who  belonged  to  the  society  of  friends. 

The  dresses  of  the  women,  in  the  years  before 
mentioned,  consisted  chiefly  of  silks  and  calicoes. 
Stays  were  universal,  and  hoops  were  generally 
worn  by  the  ladies  in  genteel  life.  Long  cloth  or 
camblet  cloaks  were  common,  in  cold  weather, 
among  all  classes  of  women. 

The  principal  custom  under  this  head,  which  in- 
fluenced health  and  life,  was  that  which  obliged 
women,  after  lying-in,  "  to  sit  up  for  company  ;" 
that  is,  to  dress  themselves,  every  afternoon  on  the 
second  week  after  their  confinement,  and  to  sit  for 
four  or  five  hours,  exposed  to  the  impure  air  of  a 
crowded  room,  and  sometimes  to  long  and  loud 
conversations. 

Porches  were   nearly  universal   appendages  to 
houses,  and  it  was  common  for  ail  the  branches  of 
a  family  to  expose  themselves  upon  them,  to  the 
evening  air.     Stoves  were  not  in  use,  at  that  time, 
in  any  places  of  public  worship. 

Funerals  were  attended  by  a  large  concourse  of 
citizens,  who  were  thereby  often  exposed  to  great 
vol.   iv.  3  A. 


370  STATE    OF    MEDICINE, 

heat  and  cold,  and  sometimes  to  standing,  while 
the  funeral  obsequies  were  performed,  in  a  wet  or 
damp  church-yard. 

The  human  mind,  in  this  period  of  the  history 
of  our  city,  was  in  a  colonized  state,  and  the  pas- 
sions acted  but  feebly  and  partially  upon  literary 
and  political  subjects. 

We  come  now  to  mention  the  diseases  which 
prevailed  in  our  city  between  the  years  1760  and 
1766. 

The  cholera  morbus  was  a  frequent  disease  in 
the  summer  months. 

Sporadic  cases  of  dysentery  were  at  that  time 
common.  I  have  never  seen  that  disease  epidemic 
in  Philadelphia. 

The  intermitting  fever  prevailed  in  the  month  of 
August,  and  in  the  autumn,  chiefly  in  the  suburbs 
and  neighbourhood  of  the  city.  In  the  year  1765, 
it  was  epidemic  in  South wark,  and  was  so  general, 
at  the  same  time,  as  to  affect  two  thirds  of  the  in- 
habitants of  the  southern  states.  This  fact  is  men- 
tioned by  Dr.  Bond,  in  a  lecture  preserved  in  the 


BETWEEN   1760  AND  1766,  AND   1805.     371 

minutes  of  the  managers  of  the  Pennsylvania  hos- 
pital. 

The  slow  chronic  fever,  called  at  that  time  the 
nervous  fever,  was  very  common,  in  the  autumnal 
months,  in  the  thickly  settled  parts  of  the  city. 

The  bilious  fever  prevailed,  at  the  same  time,  in 
Southwark.  The  late  Dr.  Clarkson,  who  began 
to  practise  medicine  in  that  part  of  the  city,  in  the 
year  1761,  upon  hearing  some  of  his  medical 
brethren  speak  of  the  appearance  of  bilious  remit- 
tents in  its  middle  and  northern  parts,  about  the 
year  1778,  said  they  had  long  been  familiar  to  him, 
and  that  he  had  met  with  them  every  year  since  his 
settlement  in  Philadelphia*. 

*  From  the  early  knowledge  this  excellent  physician  and 
worthy  man  had  thus  acquired  of  the  bilious  remitting  fever, 
he  was  very  successful  in  the  treatment  of  it.  It  was  by  in- 
struction conveyed  by  him  to  me  with  peculiar  delicacy,  that  I 
was  first  taught  the  advantages  of  copious  evacuations  from 
the  bowels  in  that  disease.  I  had  been  called,  when  a  young 
practitioner,  to  visit  a  gentleman  with  him  in  a  bilious 
pleurisy.  A  third  or  fourth  bleeding,  which  I  advised, 
cured  him.  The  doctor  was  much  pleased  with  its  effect, 
and  said  to  me  afterwards,  "  Doctor,  you  and  I  have  each  a 
great  fault  in  our  practice  j  I  do  not  bleed  enough,  you  do 
not  purge  enough." 


372  STATE    OF    MEDICINE, 

The  yellow  fever  prevailed  in  the  neighbourhood 
of  Spruce- street  wharf,  and  near  a  filthy  stream  of 
■water  which  flowed  through  what  is  now  called 
Dock- street,  in  the  year  1762.  Some  cases  of  it 
appeared  likewise  in  Southwark.  It  was  scarcely 
known  in  the  north  and  west  parts  of  the  city.  No 
desertion  of  the  citizens  took  place  at  this  time, 
nor  did  the  fear  of  contagion  drive  the  friends  of 
the  sick  from  their  bed-sides,  nor  prevent  the  usual 
marks  of  respect  being  paid  to  them  after  death,  by 
following  their  bodies  to  the  grave.  A  few  spora- 
dic cases  of  the  same  grade  of  fever  appeared  in 
the  year  1763. 

Pneumonies,  rheumatisms,  inflammatory  sore 
throats,  and  catarrhs  were  frequent  during  the  win- 
ter and  spring  months.  The  last  disease  was  in- 
duced, not  only  by  sudden  changes  in  the  weather, 
but  often  by  exposure  to  the  evening  air,  on  porches 
in  summer,  and  by  the  damp  and  cold  air  of  places 
of  public  worship  in  winter. 

The  influenza  was  epidemic  in  the  city  in  the 
spring  of  the  year  1761. 

The  malignant  sore  throat  proved  fatal  to  a  num- 
ber of  children  in  the  winter  of  1763. 


BETWEEN    1760  AND   1766,   AND    1805.    373 

The  scarlet  fever  prevailed  generally  in  the  year 
1764.  It  resembled  the  same  disease,  as  described 
by  Dr.  Sydenham,  in  not  being  accompanied  by  a 
sore  throat. 

Death  from  convulsions  in  pregnant  women,  al- 
so from  parturition,  and  the  puerperile  fever,  were 
common  between  the  years  1760  and  1766.  Death 
was  likewise  common  between  the  50th  and  60th 
years  of  life  from  gout,  apoplexy,  palsy,  obstructed 
livers,  and  dropsies.  A  club,  consisting  of  about 
a  dozen  of  the  first  gentlemen  in  the  city,  all  paid, 
for  their  intemperance,  the  forfeit  of  their  lives  be- 
tween those  ages,  and  most  of  them  with  some  one, 
or  more  of  the  diseases  that  have  been  mentioned. 
I  sat  up  with  one  of  that  club  on  the  night  of  his 
death.  Several  of  the  members  of  it  called  at  his 
house,  the  evening  before  he  died,  to  inquire  how 
he  was.  One  of  them,  upon  being  informed  of  his 
extreme  danger,  spoke  in  high  and  pathetic  terms 
of  his  convivial  talents  and  virtues,  and  said,  "  he 
had  spent  200  evenings  a  year  with  him,  for  the 
last  twenty  years  of  his  life."  These  evenings 
wrere  all  spent  at  public  houses. 

The  colica  pictonum,  or  dry  gripes,  was  for- 
merly a  common  disease  in  this  city.  It  was 
sometimes  followed  by  a  palsy  of  the  upper  and 


374  STATE    OF    MEDICINE, 

lower  extremities.  Colics  from  crapulas  were  like- 
wise very  frequent,  and  now  and  then  terminated 
in  death. 

Many  children  died  of  the  cholera  infantum,  cy- 
nanche  trachealis,  and  hydrocephalus  internus.  The 
last  disease  was  generally  ascribed  to  worms. 

Fifteen  or  twenty  deaths  occurred,  every  sum- 
mer, from  drinking  cold  pump  water,  when  the 
body  was  in  a  highly  excitable  state,  from  great 
heat  and  labour. 

The  small-pox,  within  the  period  alluded  to,  was 
sometimes  epidemic,  and  carried  off  many  citizens. 
In  the  year  1759,  Dr.  Barnet  was  invited  from  Eli- 
zabeth-town, in  New- Jersey,  to  Philadelphia,  to  ino- 
culate for  the  small-pox.  The  practice,  though  much 
opposed,  soon  became  general.  About  that  time, 
Dr.  Redman  published  a  short  defence  of  it,  and 
recommended  the  practice  to  his  fellow-citizens  in 
the  most  affectionate  language.  The  success  of 
inoculation  was  far  from  being  universal.  Subse- 
quent improvements  in  the  mode  of  preparing  the 
body,  and  treating  the  eruptive  fever,  have  led  us 
to  ascribe  this  want  of  success  to  the  deep  wound 
made  in  the  arm,  to  the  excessive  quantity  of  mer- 


BETWEEN  1760  AND  1766,  AND  1805.    375 

cury  given  to  prepare  the  body,  and  to  the  use  of  a 
warm  regimen  in  the  eruptive  fever. 

The  peculiar  customs  and  the  diseases  which 
have  been  enumerated,  by  inducing  general  weak- 
ness, rendered  the  pulmonary  consumption  a  fre- 
quent disease  among  both  sexes. 

Pains  and  diseases  from  decayed  teeth  were  very 
common,  between  the  years  1760  and  1766.  At 
that  time,  the  profession  of  a  dentist  was  unknown 
in  the  city. 

The  practice  of  physic  and  surgery  were  united, 
during  those  years,  in  the  same  persons,  and  physi- 
cians were  seldom  employed  as  man-midwives, 
except  in  preternatural  and  tedious  labours. 

The  practice  of  surgery  was  regulated  by  Mr. 
Sharp's  treatise  upon  that  branch  of  medicine. 

Let  us  now  take  a  view  of  the  medical  opinions 
which  prevailed  at  the  above  period,  and  of  the  re- 
medies which  were  employed  to  cure  the  diseases 
that  have  been  mentioned. 

The  system  of  Dr.  Boerhaave  then  governed  the 
practice  of  every  physician  in  Philadelphia.     Of 


376  STATE    OF    MEDICINE, 

course  diseases  were  ascribed  to  morbid  acrimo- 
nies, and  other  matters  in  the  blood,  and  the  prac- 
tice of  those  years  was  influenced  by  a  belief  in 
them.  Medicines  were  prescribed  to  thin,  and  to 
incrassate  the  blood,  and  diet  drinks  were  adminis- 
tered in  large  quantities,  in  order  to  alter  its  quali- 
ties. Great  reliance  was  placed  upon  the  powers 
of  nature,  and  critical  days  were  expected  with  so- 
licitude, in  order  to  observe  the  discharge  of  the 
morbid  cause  of  fevers  from  the  system.  This 
matter  was  looked  for  chiefly  in  the  urine,  and 
glasses  to  retain  it  were  a  necessary  part  of  the  fur- 
niture of  every  sick  room.  To  ensure  the  dis- 
charge of  the  supposed  morbid  matter  of  fevers 
through  the  pores,  patients  were  confined  to  their 
beds,  and  fresh,  with  cool  air,  often  excluded  by 
close  doors  and  curtains.  The  medicines  to  pro- 
mote sweats  were  generally  of  a  feeble  nature. 
The  spiritus  mindereri,  and  the  spirit  of  sweet  ni- 
tre were  in  daily  use  for  that  purpose.  In  danger- 
ous cases,  saffron  and  Virginia  snake-root  were 
added  to  them. 

Blood-letting  was  used  plentifully  in  pleurisies 
and  rheumatisms,  but  sparingly  in  all  other  diseas- 
es. Blood  was  often  drawn  from  the  feet,  in  order 
to  excite  a  revulsion  of  disease  from  the  superior 
parts  of  the  body.     It  was  considered  as  unsafe,  at 


BETWEEN  1760  AND   1766,  AND    1805.    377 

that  time,  to  bleed  during  the  monthly  disease  of 
the  female  sex. 


Purges  or  vomits  began  the  cure  of  all  febrile 
diseases,  but  as  the  principal  dependence  was  placed 
upon  sweating  medicines,  those  powerful  remedies 
were  seldom  repeated  in  the  subsequent  stages  of 
fevers.  To  this  remark  there  was  a  general  ex- 
ception in  the  yellow  fever  of  1762.  Small  doses 
of  glauber's  salts  were  given  every  day  after  bleed- 
ing, so  as  to  promote  a  gentle,  but  constant  dis= 
charge  from  the  bowels. 

The  bark  was  administered  freely  in  intermit- 
tents.  The  prejudices  against  it  at  that  time  were 
so  general  among  the  common  people,  that  it  was 
often  necessary  to  disguise  it.  An  opinion  pre- 
vailed among  them,  that  it  lay  in  their  bones,  and 
that  it  disposed  them  to  take  cold.  It  was  seldom 
given  in  the  low  and  gangrenous  states  of  fever, 
when  they  were  not  attended  with  remissions. 

The  use  of  opium  was  confined  chiefly  to  ease 
pain,  to  compose  a  cough,  and  to  restrain  preterna- 
tural discharges  from  the  body.  Such  were  the 
prejudices  against  it,  that  it  was  often  necessary  to 
conceal  it  in  other  medicines.  It  was  rarely  taken 
without  the  advice  of  a  physician. 

vol.   iv.  3    B 


378  STATE    OF    MEDICINE, 

Mercury  was  in  general  use  in  the  years  that 
have  been  mentioned.  I  have  said  it  was  given  to 
prepare  the  body  for  the  small-pox.  It  was  admi- 
nistered by  my  first  preceptor  in  medicine,  Dr. 
Redman,  in  the  same  disease,  when  it  appeared  in 
the  natural  way,  with  malignant  or  inflammatory 
symptoms,  in  order  to  keep  the  salivary  glands 
open  and  flowing,  during  the  turn  of  the  pock. 
He  gave  it  likewise  liberally  in  the  dry  gripes.  In 
one  case  of  that  disease,  I  well  remember  the  plea- 
sure he  expressed,  in  consequence  of  its  having 
a  fleeted  his  patient's  mouth. 

But  to  Dr.  Thomas  Bond  the  city  of  Philadel- 
phia is  indebted  for  the  introduction  of  mercury 
into  general  use,  in  the  practice  of  medicine.  He 
called  it  emphatically  "  a  revolutionary  remedy," 
and  prescribed  it  in  all  diseases  which  resisted  the 
common  modes  of  practice.  He  gave  it  liberally 
in  the  c}^nanche  trachealis.  He  sometimes  cured 
madness,  by  giving  it  in  such  quantities  as  to  ex- 
cite a  salivation.  He  attempted  to  cure  pulmonary 
consumption  by  it,  but  without  success ;  for,  at 
that  time,  the  influence  of  the  relative  actions  of 
different  diseases  and  remedies,  upon  the  human 
body,  was  not  known,  or,  if  known,  no  advantage 
was  derived  from  it  in  the  practice  of  medicine. 


BETWEEN  1760  AND  1766,   AND   1805.    379 

The  dry  gripes  were  cured,  at  that  time,  by  a 
new  and  peculiar  mode  of  practice,  by  Dr.  Thomas 
Cadwallader.  He  kept  the  patient  easy  by  gentle 
anodynes,  and  gave  lenient  purges  only  in  the  be- 
ginning of  the  disease  ;  nor  did  he  ever  assist  the 
latter  by  injections  till  the  fourth  and  fifth  days, 
at  which  time  the  bowels  discharged  their  contents 
in  an  easy  manner.  It  was  said  this  mode  of  cure 
prevented  the  paralytic  symptoms,  which  some- 
times follow  that  disease.  It  was  afterwards  adopted 
and  highly  commended  by  the  late  Dr.  Warren,  of 
London. 

Blisters  were  in  general  use,  but  seldom  applied 
before  the  latter  stage  of  fevers.  They  were  pre- 
scribed, for  the  first  time,  in  haemorrhages,  and 
with  great  success,  by  Dr.  George  Glentworth. 

Wine  was  given  sparingly,  even  in  the  lowest 
stage  of  what  were  then  called  putrid  and  nervous 
fevers. 

The  warm  and  cold  baths  were  but  little  used 
in  private  practice.  The  former  was  now  and  then 
employed  in  acute  diseases.  They  were  both  used 
in  the  most  liberal  manner,  together  with  the  va- 
pour and  warm  air  baths,  in  the  Pennsylvania  hos- 
pital, by  Dr.  Thomas  Bond.      An  attempt  was 


380  STATE    OF    MEDICINfe, 

made  to  erect  warm  and  cold  baths,  in  the  neigh- 
bourhood of  the  city,  and  to  connect  them  with  a 
house  of  entertainment,  by  Dr.  Lauchlin  M'Clen, 
in  the  year  1761.  The  project  was  considered  as 
unfriendly  to  morals,  and  petitions,  from  several 
religious  societies,  were  addressed  to  the  governor 
of  the  province,  to  prevent  its  execution.  The 
enterprize  was  abandoned,  and  the  doctor  soon 
afterwards  left  the  city. 

Riding  on  horseback,  the  fresh  air  of  the  sea- 
shore, and  long  journies,  were  often  prescribed  to 
invalids,  by  all  the  physicians  of  that  day. 

I  come  now  to  mention  the  causes  which  influ- 
ence the  diseases,  also  the  medical  opinions  and  re- 
medies of  the  present  time.  In  this  part  of  our 
discourse,  I  shall  follow  the  order  of  the  first  part 
of  our  inquiry. 

I  have  already  taken  notice  of  the  changes  which 
the  climate  of  Philadelphia  has  undergone  since  the 
year  1766. 

A  change  has  of  late  years  taken  place  in  the 
dress  of  the  inhabitants  of  Philadelphia.  Wigs 
have  generally  been  laid  aside,  and  the  hair  worn 
cut  and  dressed  in  different  ways.     Round  hats, 


BETWEEN   1760  AND   1766,   AND   1805.    38^ 

with  high  crowns,  have  become  fashionable.  Um- 
brellas, which  were  formerly  a  part  of  female  dress 
only,  are  now  used  in  warm  and  wet  weather,  by 
men  of  all  ranks  in  society ;  and  flannel  is  worn 
next  to  the  skin  in  winter,  and  muslin  in  summer, 
by  many  persons  of  both  sexes.  Tight  dresses  are 
uncommon,  and  stays  are  unknown  among  our 
women.  It  is  to  be  lamented  that  the  benefits  to 
health  which  might  have  been  derived  from  the 
disuse  of  that  part  of  female  dress,  have  been  pre- 
vented by  the  fashion  of  wearing  such  light  cover- 
ings over  the  breasts  and  limbs.  The  evils  from 
this  cause,  shall  be  mentioned  hereafter. 

A  revolution  has  taken  place  in  the  diet  of  our 
citizens.  Relishes  and  suppers  are  generally  abo- 
lished ;  bitters,  to  provoke  a  preternatural  appetite, 
also  meridian  bowls  of  punch,  are  now  scarcely 
known.  Animal  food  is  eaten  onlv  at  dinner,  and 
excess  in  the  use  of  it  is  prevented,  by  a  profusion 
of  excellent  summer  and  winter  vegetables. 

Malt  liquors,  or  hydrant  water,  with  a  moderate 
quantity  of  wine,  are  usually  taken  with  those  sim- 
ple and  wholesome  meals. 

Clubs,  for  the  exclusive  purpose  of  feeding,  are 
dissolved,  and  succeeded  by  family  parties,  col- 


• 


382  STATE    OF    MEDICINE, 

lected  for  the  more  rational  entertainments  of  con- 
versation, dancing,  music,  and  chess.  Taverns 
and  beer-houses  are  much  less  frequented  than  for- 
merly, and  drunkenness  is  rarely  seen  in  genteel 
life.  The  tea  table,  in  an  evening,  has  now  become 
the  place  of  resort  of  both  sexes,  and  the  midnight 
serenade  has  taken  place  of  the  midnight  revels  of 
the  young  gentlemen  of  former  years. 

In  doing  justice  to  the  temperance  of  the  modern 
citizens  of  Philadelphia,  I  am  sorry  to  admit,  there 
is  still  a  good  deal  of  secret  drinking  among  them. 
Physicians,  who  detect  it  by  the  diseases  it  pro- 
duces, often  lament  the  inefficacy  of  their  remedies 
to  remove  them.  In  addition  to  intemperance  from 
spiritous  liquors,  a  new  species  of  intoxication  from 
opium  has  found  its  way  into  our  city.  I  have 
known  death,  in  one  instance,  induced  by  it. 

The  following  circumstances  have  had  a  favour- 
able influence  upon  the  health  of  the  present  inha- 
bitants of  Philadelphia. 

The  improvements  in  the  construction  of  mo- 
dern houses,  so  as  to  render  them  cooler  in  sum- 
mer, and  warmer  in  winter. 

The  less  frequent  practice  of  sitting  on  porches, 
exposed  to  the  dew,  in  summer  evenings. 


BETWEEN   1760  AND  1766,  AND   1805.    383 

The  universal  use  of  stoves  in  places  of  public 
worship. 

The  abolition  of  the  custom  of  obliging  lying-in 
women  to  sit  up  for  company. 

The  partial  use  of  Schuylkill  or  hydrant  water, 
for  culinary  and  other  purposes. 

The  enjoyment  of  pure  air,  in  country  seats,  in 
the  neighbourhood  of  the  city.  They  not  only 
preserve  from  sickness  during  the  summer  and  au- 
tumn, but  they  render  families  less  liable  to  dis- 
eases during  the  other  seasons  of  the  year. 

And,  lastly,  the  frequent  use  of  private,  and  pub- 
lic warm  and  cold  baths.  For  the  establishment  of 
the  latter,  the  citizens  of  Philadelphia  are  indebt- 
ed to  Mr.  Joseph  Simons. 

The  following  circumstances  have  an  unfavour- 
able influence  upon  the  health  of  our  citizens. 

Ice  creams  taken  in  excess,  or  upon  an  empty 
stomach. 

The  continuance  of  the  practice  of  attending 
funerals,  under  all  the  circumstances  that  were  men- 


384  STATE    OF    MEDICINE, 

tioned  in  describing  the  customs  which  prevailed 
in  Philadelphia,  between  the  years  1760  and  1766. 

The  combined  influence  of  great  heat  and  in- 
temperance in  drinking,  acting  upon  passions  unu- 
sually excited  by  public  objects,  on  the  4th  of  July, 
every  year. 

The  general  and  inordinate  use  of  segars. 

The  want  of  sufficient  force  in  the  water  which 
falls  into  the  common  sewers  to  convey  their  con- 
tents into  the  Delaware,  renders  each  of  their  aper- 
tures a  source  of  sickly  exhalations  to  the  neigh- 
bouring streets  and  squares. 

The  compact  manner  in  which  the  gutters  are 
now  formed,  by  preventing  the  descent  of  water 
into  the  earth,  has  contributed  very  much  to  retain 
the  filth  of  the  city,  in  those  seasons  in  which  they 
are  not  washed  by  rain,  nor  by  the  waste  water  of 
the  pumps  and  hydrants. 

The  timbers  of  many  of  the  wharves  of  the  city 
have  gone  to  decay.  The  docks  have  not  been 
cleaned  since  the  year  1774,  and  many  of  them  ex- 
pose large  surfaces  to  the  action  of  the  sun  at  low 
water.      The  buildings  have  increased  in  Water- 


BETWEEN   1760  AND   1766,  AND   1805.    385 

street,  and  with  them  there  has  been  a  great  increase 
of  that  kind  of  filth  which  is  generated  in  all  houses; 
the  stores  in  this  street  often  contain  matters  which 
putrify  ;  from  all  which  there  is,  in  warm  weather, 
a  constant  emission  of  such  a  foetid  odour,  as  to 
render  a  walk  through  that  street,  by  a  person  who 
does  not  reside  there,  extremely  disagreeable,  and 
sometimes  to  produce  sickness  and  vomiting. 

In  many  parts  of  the  vicinity  of  the  city  are  to 
be  seen  pools  of  stagnating  water,  from  which  there 
are  exhaled  large  quantities  of  unhealthy  vapours, 
during  the  summer  and  autumnal  months. 

The  privies  have  become  so  numerous,  and  are 
often  so  full,  as  to  become  offensive  in  most  of  the 
compact  parts  of  the  city,  more  especially  in  damp 
weather. 

The  pump  water  is  impregnated  with  many  sa- 
line and  aerial  matters  of  an  offensive  nature. 

While  these  causes  exert  an  unfriendly  influence 
upon  the  bodies  of  the  citizens  of  Philadelphia, 
the  extreme  elevation  or  depression  of  their  pas- 
sions, by  the  different  issues  of  their  political  con- 
tests (now  far  surpassing,  in  their  magnitude,  the 
contests  of  former  years),  together  with  their  many 

vol.   iv.  3  c 


386  STATE    OF    MEDICINE, 

new  and  fortuitous  modes  of  suddenly  acquiring 
and  losing  property,  predispose  them  to  many  dis- 
eases of  the  mind. 

The  present  diseases  of  Philadelphia  come  next 
under  our  consideration. 

Fevers  have  assumed  several  new  forms  since 
the  year  1766.  The  mild  bilious  fever  has  gradu- 
ally spread  over  every  part  of  the  city.  It  followed 
the  filth  which  was  left  by  the  British  army  in  the 
year  1778.  In  the  year  1780,  it  prevailed,  as  an 
epidemic,  in  South wark,  and  in  Water  and  Front- 
streets,  below  Market- street*.  In  the  years  1791 
and  1792,  it  assumed  an  inflammatory  appearance, 
and  was  accompanied,  in  many  cases,  with  hepatic 
affections.  The  connection  of  our  subject  requires 
that  I  should  barely  repeat,  that  it  appeared  in  1793 
as  an  epidemic,  in  the  form  of  what  is  called  yel- 
low fever,  in  which  form  it  has  appeared,  in  spora- 
dic cases,  or  as  an  epidemic,  every  year  since. 

*  It  appears,  from  the  account  given  by  Mr.  White  of 
the  bilious  fever  of  Bath,  that  it  prevailed  several  years  in 
its  suburbs,  before  it  became  general  in  that  city.  It  is  re- 
markable, that  South  wark  was  nearly  the  exclusive  seat,  not 
only  of  the  bilious  or  break-bone  fever  of  1780,  but  of  the 
intermitting  fever  in  1765,  taken  notice  of  by  Dr.  Bond,  and 
of  the  yellow  fever  of  1805. 


BEfWEEN   1760  AND   1766,  AND  1805.    387 

During  the  reign  of  this  high  grade  of  bilious  fever, 
mild  intermittents  and  remittents,  and  the  chronic 
or  nervous  forms  of  the  summer  and  autumnal 
fever,  have  nearly  disappeared. 

Inflammations  and  obstructions  of  the  liver  have 
been  more  frequent  than  in  former  years,  and  even 
the  pneumonies,  catarrhs,  intercurrent,  and  other 
fevers  of  the  winter  and  spring  months,  have  all 
partaken  more  or  less  of  the  inflammatory  and  ma- 
lignant nature  of  the  yellow  fever. 

The  pulmonary  consumption  continues  to  be  a 
common  disease  among  both  sexes*. 

The  cynanche  trachealis,  the  scarlatina  anginosa, 
the  hydrocephalus  internus,  and  cholera  infantum, 
are  likewise  common  diseases  in  Philadelphia. 

Madness,  and  several  other  diseases  of  the  mind, 
have  increased  since  the  year  1766,  from  causes 
which  have  been  mentioned. 

Several  of  the  different  forms  of  gout  are  still 
common  among  both  sexes. 

Apoplexy  and  palsy  have  considerably  dimi- 
nished in  our  city.     It  is  true,  the  bills  of  morta- 


388  STATE    OF    MEDICINE, 

lity  still  record  a  number  of  deaths  from  the  former, 
every  year ;  but  this  statement  is  incorrect,  if  it 
mean  a  disease  of  the  brain  only,  for  sudden  deaths 
from  all  their  causes  are  returned  exclusively  under 
the  name  of  apoplexy.  The  less  frequent  occur- 
rence of  this  disease,  also  of  palsy,  is  probably  oc- 
casioned by  the  less  consumption  of  animal  food, 
and  of  distilled  and  fermented  liquors,  by  that  class 
of  citizens  who  are  most  subject  to  them,  than  in 
former  years.  Perhaps  the  round  hat,  and  the  gene- 
ral use  of  umbrellas,  may  have  contributed  to  lessen 
those  diseases  of  the  brain. 

The  dropsy  is  now  a  rare  disease,  and  seldom 
seen  even  in  our  hospital. 

The  colica  pictonum,  or  dry  gripes,  is  scarcely 
known  in  Philadelphia.  I  have  ascribed  this  to 
the  use  of  flannel  next  to  the  skin  as  a  part  of 
dress,  and  to  the  general  disuse  of  punch  as  a  com- 
mon drink. 

The  natural  small-pox  is  nearly  extirpated,  and 
the  puerperile  fever  is  rarely  met  with  in  Philadel- 
phia. The  scrophula  is  much  less  frequent  than 
in  former  years.  It  is  confined  chiefly  to  persons 
in  humble  life. 


BETWEEN  1760  AND   1766,  AND  1805.    389 

I  proceed,  in  the  order  that  was  proposed,  to 
take  notice  of  the  present  medical  opinions  which 
prevail  among  the  physicians  of  Philadelphia.  The 
system  of  Dr.  Boerhaave  long  ago  ceased  to  regu- 
late the  practice  of  physic.  It  was  succeeded  by 
the  system  of  Dr.  Cullen.  In  the  year  1790,  Dr. 
Brown's  system  of  medicine  was  introduced  and 
taught  by  Dr.  Gibbon.  It  captivated  a  few  young 
men  for  a  while,  but  it  soon  fell  into  disrepute. 
Perhaps  the  high-toned  diseases  of  our  city  expos- 
ed the  fallacy  and  danger  of  the  remedies  inculcated 
by  it,  and  afforded  it  a  shorter  life  than  it  has  had  in 
many  other  countries.  In  the  year  1790,  the  au- 
thor of  this  inquiry  promulgated  some  new  princi- 
ples in  medicine,  suggested  by  the  peculiar  phe- 
nomena of  the  diseases  of  the  United  States. 
These  principles  have  been  so  much  enlarged  and 
improved  by  the  successive  observations  and  rea- 
sonings of  many  gentlemen  in  all  the  states,  as  to 
form  an  American  system  of  medicine.  This  sys- 
tem rejects  the  nosological  arrangement  of  diseases, 
and  places  all  their  numerous  forms  in  morbid  ex- 
citement, induced  by  irritants  acting  upon  previous 
debility.  It  rejects,  likewise,  all  prescriptions  for 
the  names  of  diseases,  and,  by  directing  their  ap- 
plications wholly  to  the  forming  and  fluctuating 
states  of  diseases,  and  the  system,  derives  from  a  few 
active  medicines  all  the  advantages  which  have  been 


390  STATE    OF    MEDICINE, 

in  vain  expected  from  the  numerous  articles  which 
compose  European  treatises  upon  the  materia  me- 
dica.  This  system  has  been  adopted  by  a  part  of 
the  physicians  of  Philadelphia,  but  a  respectable 
number  of  them  are  still  attached  to  the  system  of 
Dr.  Cullen. 

A  great  change  has  taken  place  in  the  remedies 
which  are  now  in  common  use  in  Philadelphia.  I 
shall  briefly  mention  such  of  them  as  are  new,  and 
then  take  notice  of  the  new  and  different  modes  of 
exhibiting  such  as  were  in  use  between  the  years 
1760  and  1766. 

Vaccination  has  been  generally  adopted  in  our 
city,  in  preference  to  inoculation  with  variolous 
matter. 

Digitalis,  lead,  zinc,  and  arsenic  are  now  com- 
mon remedies  in  the  hands  of  most  of  our  practi- 
tioners. 

Cold  air,  cold  water,  and  ice  are  among  the  new 
remedies  of  modern  practice  in  Philadelphia. 

Blood-letting  is  now  used  in  nearly  all  diseases 
of  violent  excitement,  not  only  in  the  blood-ves- 
sels, but  in  other  parts  of  the  body.    Its  use  is  not, 


BETWEEN   1760  AND   1766,  AND   1805.    391 

as  in  former  times,  limited  to  ounces  in  specific 
diseases,  but  regulated  by  their  force,  and  the  im- 
portance of  the  parts  affected  to  health  and  life ;  nor 
is  it  forbidden,  as  formerly,  in  infancy,  in  extreme 
old  age,  in  the  summer  months,  nor  in  the  period 
of  menstruation,  where  symptoms  of  a  violent,  or 
of  a  suffocated  disease,  manifested  by  an  active  or 
a  feeble  pulse,  indicate  it  to  be  necessary. 

Leeches  are  now  in  general  use  in  diseases 
which  are  removed,  by  their  seat  or  local  nature, 
beyond  the  influence  of  the  lancet.  For  the  intro- 
duction of  this  excellent  remedy  into  our  city  we 
are  indebted  to  Mr.  John  Cunitz. 

Opium  and  bark,  which  were  formerly  given  in 
disguise,  or  with  a  trembling  hand,  are  now,  not 
only  prescribed  by  physicians,  but  often  purchased, 
and  taken  without  their  advice,  by  many  of  the  citi- 
zens of  Philadelphia.  They  even  occupy  a  shelf 
in  the  closets  of  many  families. 

The  use  of  mercury  has  been  revived,  and  a  sa- 
livation has  been  extended,  with  great  improve- 
ments and  success,  to  nearly  all  violent  and  obsti- 
nate diseases.  Nor  has  the  influence  of  reason  over 
ignorance  and  prejudice,  with  respect  to  that  noble 
medicine,  stopped  here.     Cold  water,  once  sup- 


392  STATE    OF    MEDICINE, 

posed  to  be  incompatible  with  its  use,  is  now  ap- 
plied to  the  body,  in  malignant  fevers,  in  order  to 
insure  and  accelerate  its  operation  upon  the  salivary 
glands. 

Wine  is  given  in  large  quantities,  when  indi- 
cated, without  the  least  fear  of  producing  intoxi- 
cation. 

The  warm  and  cold  baths,  which  were  formerly 
confined  chiefly  to  patients  in  the  Pennsylvania 
hospital,  are  now  common  prescriptions  in  private 
practice. 

Exercise,  country  air,  and  the  sea  shore,  are 
now  universally  recommended  in  chronic  diseases, 
and  in  the  debility  which  precedes  and  follows  them. 

Great  pains  are  now  taken  to  regulate  the  quan- 
tity and  quality  of  aliments  and  drinks,  by  the  pe- 
culiar state  of  the  system. 

Let  us  now  inquire  into  the  influence  of  the  new 
opinions  in  medicine,  and  the  new  remedies  which 
have  been  mentioned,  upon  human  life. 

The  small-pox,  once  the  most  fatal  and  univer- 
sal of  all  diseases,  has  nearly  ceased  to  occupy  a 


BETWEEN   1760  AND   1765,  AND  1805.    393 

place  in  our  bills  of  mortality,  by  the  introduction 
of  vaccination  in  our  city.  For  the  prompt  adop- 
tion of  this  great  discovery,  the  citizens  of  Phila- 
delphia owe  a  large  debt  of  gratitude  to  Dr.  Coxe, 
and  Mr.  John  Vaughan. 

Fevers,  from  ail  their  causes,  and  in  all  their 
forms,  with  the  exception  of  the  bilious  yellow  fe- 
ver, now  yield  to  medicine.  Even  that  most  ma- 
lignant form  of  febrile  diseases  is  treated  with  more 
success  in  Philadelphia  than  in  other  countries. 
It  would  probably  seldom  prove  mortal,  did  a  be- 
lief in  its  being  derived  from  an  impure  atmosphere, 
and  of  its  exclusive  influence  upon  the  body,  while 
it  pre  vailed  as  an  epidemic,  obtain  universally  among 
the  physicians  and  citizens  of  Philadelphia. 

The  pulmonary  consumption  has  been  prevented, 
in  many  hundred  instances,  by  meeting  its  premo- 
nitory signs,  in  weakness  and  feeble  morbid  ex- 
citement in  the  whole  system,  by  country  air,  gen- 
tle exercise,  and  gently  stimulating  remedies. 
Even  when  formed,  and  tending  rapidly  to  its  last 
stage,  it  has  been  cured  by  small  and  frequent 
bleedings,  digitalis,  and  a  mercurial  salivation. 

The  hydrocephalus  internus,  the  cynanche  tra- 
chealis,  and  cholera  infantum,  once  so  fatal  to  the 
vol.   iv.  3  D 


394  STATE     OF    MEDICINE, 

children  of  our  city,  now  yield  to  medicine  in  their 
early  stages.  The  two  former  are  cured  by  copi- 
ous bleeding,  aided  by  remedies  formerly  employed 
in  them  without  success.  The  last  is  cured  by 
moderate  bleeding,  calomel,  laudanum,  and  coun- 
try air. 

The  gout  has  been  torn  from  its  ancient  sanc- 
tuary in  error  and  prejudice,  and  its  acute  parox- 
ysms now  yield  with  as  much  certainty  to  the  lan- 
cet, as  the  most  simple  inflammatory  diseases. 

The  dropsy  is  cured  by  renouncing  the  unfortu- 
nate association  of  specific  remedies  with  its  name, 
and  accommodating  them  to  the  degrees  of  ex- 
citement in  the  blood-vessels. 

The  tetanus  from  wounds  is  now  prevented,  in 
most  cases,  by  inflaming  the  injured  parts,  and 
thereby  compelling  them  to  defend  the  whole  sys- 
tem, by  a  local  disease.  Where  this  preventing 
remedy  has  been  neglected,  and  where  tetanus 
arises  from  other  causes  than  wounds,  it  has  often 
been  cured  by  adding  to  the  diffusible  stimulus  of 
opium,  the  durable  stimuli  of  bark  and  wine. 

Death  from  drinking  cold  water,  in  the  heated 
state  of  the  body,  is  now  obviated  by  previously 


BETWEEN   1760  AND   1766,  AND   1805.     395 

wetting  the  hands  or  feet  with  the  water ;  and  when 
this  precaution  is  neglected,  the  disease  induced  by 
it  is  generally  cured  by  large  doses  of  liquid  lau- 
danum. 

Madness,  which  formerly  doomed  its  miserable 
subjects  to  cells  or  chains  for  life,  has  yielded  to 
bleeding,  low  diet,  mercury,  the  warm  and  cold 
baths,  fresh  air,  gentle  exercise,  and  mild  treat- 
ment, since  its  seat  has  been  discovered  to  be  in 
the  blood-vessels  of  the  brain. 

The  last  achievement  of  our  science  in  Philadel- 
phia, that  I  shall  mention,  consists  in  the  discovery 
and  observation  of  the  premonitory  signs  of  violent 
and  mortal  diseases,  and  in  subduing  them  by  sim- 
ple remedies,  in  their  forming  state.  By  this 
means,  death  has  been  despoiled  of  his  prey,  in 
many  hundred  instances. 

In  this  successful  conflict  of  medicine  with  dis- 
ease and  death,  midwifery  and  surgery  have  borne 
a  distinguished  part.  They  derive  their  claims  to 
the  gratitude  of  the  citizens  of  Philadelphia  from 
the  practice  of  each  of  them  being  more  confined, 
than  formerly,  to  a  few  members  of  our  profession. 
It  is  in  consequence  of  the  former  being  exercised 
only  by  physicians  of  regular  and  extensive  educa- 


396  STATE    OF    MEDfCINE, 

tions,  that  death  from  pregnancy  and  parturition 
is  a  rare  occurrence  in  Philadelphia. 

I  should  greatly  exceed  the  limits  prescribed  to 
this  inquiry,  should  I  mention  how  much  pain  and 
misery  have  been  relieved,  and  how  often  death 
has  been  baffled  in  his  attempts  upon  human  life, 
by  several  late  improvements  in  old,  and  the  disco- 
covery  of  new  remedies  in  surgery.  I  shall  briefly 
name  a  few  of  them. 

In  cases  of  blindness,  from  a  partial  opacity  of 
the  cornea,  or  from  a  closure  of  the  natural  pupil, 
a  new  pupil  has  been  made  ;  and  where  the  cornea 
has  been  partially  opaque,  the  opening  through  the 
iris  has  been  formed,  opposite  to  any  part  of  it, 
which  retained  its  transparency. 

The  cure  of  fractures  has  been  accelerated  by 
blood-letting,  and,  where  the  union  of  a  broken 
bone  has  not  taken  place  from  a  defect  of  bony 
matter,  it  has  been  produced  by  passing  a  seton  be- 
tween  the  fractured  ends  of  the  bone,  and  effecting 
a  union  thereby  between  them.  Luxations,  which 
have  long  resisted  both  force  and  art,  have  been 
reduced  in  a  few  minutes,  and  without  pain,  by 
bleeding  at  deliquium  animi. 


BETWEEN   1760  AND   1766,  AND   1805.    397 

Old  sores  have  been  speedily  healed,  by  des- 
troying their  surfaces,  and  thereby  placing  them  in 
the  condition  of  recent  accidents. 

The  fruitless  application  of  the  trepan,  in  con- 
cussions of  the  brain,  has  been  prevented  by  copi- 
ous bleeding,  and  a  salivation. 

A  suppression  of  urine  has  been  cured,  by  the 
addition  of  a  piece  of  a  bougie  to  a  flexible  cathe- 
ter. 

Strictures  in  the  urethra  have  been  removed  by 
means  of  a  caustic,  also,  in  a  more  expeditious  way, 
by  dividing  them  with  a  lancet. 

Hydrocele  has  been  cured  by  a  small  puncture, 
and  afterwards  exciting  inflammation  and  adhesion 
by  an  injection  of  wine  into  the  tunica  vaginalis 
testis. 

The  popliteal  aneurism  and  varicose  veins  have 
both  been  removed  by  operations  that  were  un- 
known a  few  years  ago. 

For  the  introduction  of  several  of  those  new  sur- 
gical remedies,  and  for  the  discovery  and  improve- 
ment of  others,  the  citizens  of  Philadelphia  are  in- 


398  STATE    OF    MEDICINE, 

debted  to  Dr.  Physick.  They  are  likewise  indebted 
to  him  and  Dr.  Griffitts  for  many  of  the  new  and 
successful  modes  of  practice,  in  the  diseases  that 
have  been  mentioned.  Even  the  few  remedies  that 
have  been  suggested  by  the  author  of  these  inqui- 
ries, owe  their  adoption  and  usefulness  chiefly  to 
the  influence  of  those  two  respectable  and  popular 
physicians. 

Before  I  dismiss  this  part  of  our  subject,  I  have 
only  to  add,  that  since  the  cure  and  extraction  of 
the  teeth  have  become  a  distinct  branch  of  the  pro- 
fession of  medicine,  several  diseases  which  have 
arisen  from  them,  when  decayed,  have  been  de- 
tected and  cured*. 

We  have  thus  taken  a  comparative  view  of  the 
medical  theories  and  remedies  of  former  and  mo- 
dern times,  and  of  their  different  influence  upon 
human  life.  To  exhibit  the  advantages  of  the  lat- 
ter over  the  former,  I  shall  mention  the  difference 
in  the  number  of  deaths  in  three  successive  years, 
at  a  time  when  the  population  of  the  city  and  sub- 
urbs was  supposed  to  amount  to  30,000  souls, 


*  The  late  Mr.  Andrew  Spence  was  the  first  regular  bred 
dentist  that  settled  in  Philadelphia.  There  are  now  several 
well  educated  gentlemen  in  the  city  of  that  profession. 


BETWEEN   1760  AND   1766,  AND    1805.    399 

and  in  three  years,  after  the  population  exceeded 
double  that  number. 


Between  the  25th  of  December,  1771,  and  the 
25th  of  December,  1772,  there  died  1291  persons. 

Between  the  same  days  of  the  same  months,  in 
1772  and  1773,  there  died  1344  persons. 

Within  the  same  period  of  time,  between  1773 
and  1774,  the  deaths  amounted  to  1021,  making 
in  all  3,656.  I  regret  that  I  have  not  been  able  to 
procure  the  returns  of  deaths  in  years  prior  to  those 
which  have  been  mentioned.  During  the  three 
years  that  have  been  selected,  no  unusually  mor- 
tal diseases  prevailed  in  the  city.  The  measles 
were  epidemic  in  1771,  but  were  not  more  fatal 
than  in  common  years. 

Between  the  25th  of  December,  1799,  and  the 
25th  of  December,  1800,  there  died  1525  persons. 

Between  the  same  days  of  the  same  months,  in 
the  years  1801  and  1802,  there  died  1362  persons, 

Within  the  same  period  of  time,  between  1802 
and  1803,  the  deaths  amounted  to  1796,  making 
in  all  4,883. 


400     .  STATE    OF    MEDICINE, 

Upon  these  returns  it  will  be  proper  to  remark, 
that  several  hundreds  of  the  deaths,  in  1802  and 
1803,  were  from  the  yellow  fever,  and  that  many 
of  them  were  of  strangers.  Of  68  persons,  who  were 
interred  in  the  Swedes'  church-yard  alone,  one  half 
were  of  that  description  of  people.  Deducting  500 
from  both  those  causes  of  extra- mortality  in  the 
three  years,  between  1799  aud  1803,  the  increase  of 
deaths  above  what  they  were  in  the  years  1771  and 
1774  is  but  727.  Had  diseases  continued  to  be  as 
mortal  as  they  were  thirty  years  ago,  considering 
the  present  state  of  our  population,  the  number 
of  deaths  would  have  been  more  than  7,312. 

To  render  the  circumstances  of  the  statement  of 
deaths  that  has  been  given  perfectly  equal,  it  will 
be  necessary  to  add,  that  the  measles  prevailed  in 
the  city,  in  the  year  1802,  as  generally  as  they  did 
in  1771. 

From  the  history  that  lias  been  given,  of  the 
effects  of  the  late  improvements  and  discoveries  in 
medicine  upon  human  life,  in  Philadelphia,  we  are 
led  to  appreciate  its  importance  and  usefulness.  It 
has  been  said,  by  its  enemies,  to  move ;  but  its 
motions  have  been  asserted  to  be  only  in  a  circle. 
The  facts  that  have  been  stated  clearly  prove,  that 


BETWEEN   1760  AND   1766,   AND   1805.    401 

it  has  moved,  and  rapidly  too,  within  the  last  thirty 
years,  in  a  straight  line. 

To  encourage  and  regulate  application  and  enter- 
prize  in  medicine  hereafter,  let  us  inquire  to  what 
causes  we  are  indebted  for  the  late  discoveries  and 
improvements  in  our  science,  and  for  their  happy 
effects  in  reducing  the  number  of  deaths  so  far  be- 
low their  former  proportion  to  the  inhabitants  of 
Philadelphia. 

The  first  cause  I  shall  mention  is  the  great  phy- 
sical changes  which  have  taken  place  in  the  man- 
ners of  our  citizens  in  favour  of  health  and  life. 

A  second  cause,  is  the  assistance  which  has  been 
afforded  to  the  practice  of  physic,  by  the  numerous 
and  important  discoveries  that  have  lately  been 
made  in  anatomy,  natural  history,  and  chemistry, 
all  of  which  have  been  conveyed,  from  time  to  time, 
to  the  physicians  of  the  city,  by  means  of  the  Phi- 
ladelphia and  hospital  libraries,  and  by  the  lectures 
upon  those  branches  of  science  which  are  annually 
delivered  in  the  university  of  Pennsylvania. 

3.  The  application  of  reasoning  to  our  science 
has  contributed  greatly  to  extend  its  success  in  the 
cure  of  diseases.     Simply  to  observe  and  to  re- 
volt,  iv.  3  E 


402  STATE    OF    MEDICINE, 

member,  are  the  humblest  operations  of  the  human 
mind.  Brutes  do  both.  But  to  theorize,  that  is, 
to  think,  or,  in  other  language,  to  compare  facts, 
to  reject  counterfeits,  to  dissolve  the  seeming  affi- 
nity of  such  as  are  not  true,  to  combine  those  that 
are  related,  though  found  in  remote  situations  from 
each  other,  and,  finally,  to  deduce  practical  and 
useful  inferences  from  them,  are  the  high  preroga- 
tives and  interest  of  man,  in  all  his  intellectual  pur- 
suits, and  in  none  more,  than  in  the  profession  of 
medicine. 

4.  The  accommodation  of  remedies  to  the  changes 
which  are  induced  in  diseases  by  the  late  revolu- 
tions in  our  climate,  seasons,  and  manners,  has  had 
a  sensible  influence  in  improving  the  practice  of 
medicine  in  our  city.  The  same  diseases,  like  the 
descendants  of  the  same  families,  lose  their  resem- 
blance to  each  other  by  the  lapse  of  time  ;  and  the 
almanacks  of  1803  might  as  well  be  consulted  to 
inform  us  of  the  monthly  phases  of  the  moon  of 
the  present  year,  as  the  experience  of  former  years, 
or  the  books  of  foreign  countries,  be  relied  upon 
to  regulate  the  practice  of  physic  at  the  present 
time,  in  any  of  the  cities  of  the  United  States. 

5.  From  the  diffusion  of  medical  knowledge 
among  all  classes  of  our  citizens,  by  means  of  me- 


BETWEEN   1760  AND  1766,   AND   1805.    403 

dical  publications,  and  controversies,  many  people 
have  been  taught  so  much  of  the  principles  and 
practice  of  physic,  as  to  be  able  to  prescribe  for 
themselves  in  the  forming  state  of  acute  diseases, 
and  thereby  to  prevent  their  fatal  termination.  It 
is  to  this  self- acquired  knowledge  among  the  citi- 
zens of  Philadelphia,  that  physicians  are  in  part  in- 
debted for  not  being  called  out  of  their  beds  so 
frequently  as  in  former  years.  There  are  few  peo- 
ple who  do  not  venture  to  administer  laudanum  in 
bowel  complaints,  and  there  are  some  persons  in 
the  city,  who  have  cured  the  cynanche  trachealis 
when  it  has  occurred  in  the  night,  by  vomits  and 
bleeding,  without  the  advice  of  a  physician.  The 
disuse  of  suppers  is  another  cause  why  physicians 
enjoy  more  rest  at  night  than  formerly,  for  many 
of  their  midnight  calls,  were  to  relieve  diseases 
brought  on  by  that  superfluous  meal. 

6.  The  dispensary  instituted  in  our  city,  in  the 
year  1786,  for  the  medical  relief  of  the  poor,  has 
assisted  very  much  in  promoting  the  empire  of  me- 
dicine over  disease  and  death.  Some  lives  have 
likewise  been  saved  bv  the  exertions  of  the  humane 
society,  by  means  of  their  printed  directions  to  pre- 
vent sudden  death ;  also,  by  the  medical  services 
which  have  lately  been  extended  to  out-patients, 


404  STATE    OF    MEDICINE, 

by  order  of  the  managers  of  the  Pennsylvania  hos- 
pital. 

7thly  and  lastly.  A  change,  favourable  to  suc- 
cessful practice  in  Philadelphia,  has  taken  place  in 
the  conduct  of  physicians  to  their  patients.  A  sick 
room  has  ceased  to  be  the  theatre  of  imposture  in 
dress  and  manners,  and  prescriptions  are  no  longer 
delivered  with  the  pomp  and  authority  of  edicts. 
On  the  contrary,  sick  people  are  now  instructed  in 
the  nature  of  their  diseases,  and  informed  of  the 
names  and  design  of  their  medicines,  by  which 
means  faith  and  reason  are  made  to  co-operate  in 
adding  efficacy  to  them.  Nor  are  patients  left,  as 
formerly,  by  their  physicians,  under  the  usual  ap- 
pearances of  dissolution,  without  the  aid  of  medi- 
cine. By  thus  disputing  every  inch  of  ground 
with  death,  many  persons  have  been  rescued  from 
the  grave,  and  lived,  years  afterwards,  monuments 
of  the  power  of  the  healing  art. 

From  a  review  of  what  has  been  effected  within 
the  last  nine  and  thirty  years,  in  lessening  the  mor- 
talitv  of  manv  diseases,  we  are  led  to  look  forward 
with  confidence  and  pleasure  to  the  future  achieve- 
ments of  our  science. 


BETWEEN   1760  AND   1766,   AND   1805.    405 

Could  we  lift  the  curtain  of  time  which  separates 
the  year  1843  from  our  view,  we  should  see  can- 
cers, pulmonary  consumptions,  apoplexies,  palsies, 
epilepsy,  and  hydrophobia  struck  out  of  the  list  of 
mortal  diseases,  and  many  others  which  still  retain 
an  occasional  power  over  life,  rendered  perfectly 
harmless,  provided  the  same  number  of  discoveries 
and  improvements  shall  be  made  in  medicine  in  the 
intermediate  years,  that  have  been  made  since  the 
year  1766. 

But  in  vain  will  the  avenues  of  death  from  those 
diseases  be  closed,  while  the  more  deadly  yellow 
fever  is  permitted  to  supply  their  place,  and  to 
spread  terror,  distress,  and  poverty  through  the 
city,  by  destroying  the  lives  of  her  citizens  by 
hundreds  or  thousands  every  year.  Dear  cradle 
of  liberty  of  conscience  in  the  western  world!  nurse 
of  industry  and  arts  !  and  patron  of  pious  and  be- 
nevolent institutions  !  may  this  cease  to  be  thy  me- 
lancholy destiny  !  May  Heaven  dispel  the  errors 
and  prejudices  of  thy  citizens  upon  the  cause  and 
means  of  preventing  their  pestilential  calamities ! 
and  may  thy  prosperity  and  happiness  be  revived, 
extended,  and  perpetuated  for  ages  yet  to  come  ! 


/■ 


INDEX. 


ANTHELMINTICS                   -  i.  228 

Arsenic,  a  remedy  for  cancerous  sores  i.  240 

Army  of  the  United  States,  diseases  of  i.  269 

,  causes  of                          -  i.  272 

— ,  remedies  for                         -  i.  ibid. 

Agriculture,   the  practice  of,  recommended  to 

country  physicians                     -  i.  388 
Age,  old,  observations  on  the  state  of  the  body 

and  mind  in                          -  "  i.  427 

i  ,  its  diseases                     -  i.  446 

, ,  their  remedies                 -  i.  449 

Association  of  ideas,  its  effects  upon  morals  ii.  45 
Air,  cool,  its  good  effects  in  the  yellow  fever  of 

1793                           -                          -  Hi.  279 


INDEX. 

B. 

Barometer,  its  mean  elevation  in  Philadelphia     i.  96 

Blisters,  their  efficacy  in  obstinate  intermittents  i.  179 

, in  the  bilious  fever  of  1780                  i.  128 

, in  the  yellow  fever  of  1803,  when 

applied  in  its  early  stage                                     iv.  141 
Bed,  lying  in,  useful  in  the  bilious  fever  of  1780  i.  128 
Bleeding,  its  efficacy  in  the  cure  of  obstinate  in- 
termittents                         -                      -             i.  179 

, in  the  yellow  fever  of  1 793                 iii.  253 

,  reasons  for  the  practice                                iii.  254 

,  circumstances  which  regulated  it                iii.  261 

,  objections  to  it  answered                             iii.  269 

,  gradual  manner  of  abstracting  blood  re- 
commended                     -                      -             iii.  273 
Blood-letting,  defence  of  it  as  a  remedy  for  cer- 
tain diseases                          -                               iv.  275 

,  indicated  in  fevers                          -               iv.  ibid. 

,  its  good  effects  in  fevers                               iv.  277 

,  objections  to  it  answered                             iv.  284 

,  its  comparative  advantages                          iv.  313 

,  circumstances  which  should  regulate  its  use  iv.  316 

,  appearances  of  the  blood                               iv.  326 

,  when  forbidden,  or  to  be  used  cautiously  iv.  344 

,  its  advantages  in  pregnancy                         iv.  349 

,  in  parturition                           -                        iv.  353 

,  during  the  cessation  of  the  menses            iv.  356 

,  in  curing  the  disease  induced  by  a  large 

dose  of  opium  -  -  iv.  357 
— ,  in  curing  the  disease  induced  by  poison  iv.  ibid. 
*,  in  diabetes                 -                 -                  iv.  ibid. 


INDEX. 

Blood-letting,  in  dislocated  bones                         iv.  358 
Blood,  quantity  drawn  from  several  persons  in 

1797  -  -  iv.  37 
— ,  appearances  of  it  in  1 793  iii.  256 
, in  1794                                                  iii.  404 


32 
60 
71 
76 
78 


C. 

Civilization,  diseases  derived  from  it 

,         ■  not  necessarily  connected  with  it 

Climate  of  Pennsylvania,  account  of 

,  its  changes 

— — ,  its  temperature 

,  its  effects  upon  health  and  Hfe  fc     108 

Calomel,  useful  joined  with  emetics  in  scarlatina 

anginosa  i.     144 
,  its  effects  as  a  purge,  when  combined  with 

jalap,  in  the  yellow  fever 

,  objections  to  it  answered 

Contagious,  the  yellow  fever  not  so 
Cholera  infantum  described 

,  a  form  of  bilious  fever 

,  its  remedies 

,  means  of  preventing  it 

Cynanche  trachealis,  its  different  names 

appearances  in  the  trachea  after  death 

,  its  different  grades  "\  - 

,  its  remedies  in  its  forming  state 

,  its  remedies  after  it  is  formed 

,  favourable  and  unfavourable  signs  of  its 

issue  - 

Consumption,  pulmonary,  thoughts  on 

vol.   iv.  3  F 


•  •  • 

HI. 

241 

•  •  • 

111. 

243 

iv. 

223 

• 

i. 

157 

i. 

158 

• 

l. 

160 

i. 

164 

i. 

169 

i. 

170 

i. 

171 

• 

l. 

ibid. 

i. 

172 

i. 

174 

• 

i. 

199 

INDEX. 

Consumption,  pulmonary,  Indians,  and  persons 

who  lead  laborious  lives,  not  subject  to  it  i.  200 
,  radical  remedies  for  it  in  exercise,  labour, 

and  the  hardships  of  a  camp  and  naval  life      i.  204 

,  its  causes                  -                      -                 ii.  62 

not  contagious                 -                 -             ii.  79 

— ,  tracheal,  described                  -                     ii.  84 

,  its  remedies                 -                -                 ii.  87 

— ,  premonitory  signs                    -                     ii.  ibid. 

,  of  the  remedies  for  its  inflammatory  state  ii.  89 

• ,  of  blood-letting                     -                        ii.  ibid- 

,  of  a  vegetable  diet                       -                 ii.  104 

,  of  the  remedies  for  its  hectic  state              ii.  107 

— ,  for  its  typhus  state                     -                  ii.  108 

,  of  its  radical  remedies                -                 ii.  128 

— ,  of  exercise                  -                       -             ii.  ibid. 

,  of  travelling                          -                          ii.  137 

,  signs  of  its  long  or  short  duration,  and  of 

its  issue  in  life  and  death                  -                  ii.  144 

,  its  different  ways  of  terminating  in  death  ii.  147 

College  of  physicians,  their  letter  to  the  citizens 

of  Philadelphia,  declaring  the  existence  of  the 

yellow  fever  in  the  city,  &c.  in  1793  ii i-  82 
,  their  letter  to  the  governor  of  the  state, 

on  the  origin  of  the  yellow  fever  in  1793  iii.  197 
,  their  opinion  of  the  origin  of  the  fever  in 

1799                          -                          -                  iv.  100 

D. 

Diseases  of  the  Indians                      -                      i.  16 
from  civilization             -                  -              i.  30 


INDEX. 

Diseases  produced  by  ardent  spirits  i.     343 

—  of  the  military  hospitals,  during  the  revo- 
lutionary war  between  Great-Britain  and  the 
United  States 
'■■      of  old  age 

Drunkenness,  a  fit  of  it  described 
,  remedies  for  it 

Disease,  summer  and  autumnal,  its  sources 

— ,  means  of  preventing  it  in  its  malignant 
forms  t  i  * 

— — ,  in  its  mild  forms 

,  in  its  intestinal  forms 

,  of  preserving  cities  and  communities  from 

them  -  - 

— ,  of  exterminating  them 

from  drinking  cold  water 

— — ,  — ,  how  prevented 

— — ,  — -,  its  cure 

Dropsies,  their  causes 

— ,  divided  into  inflammatory,  and  of  weak 
morbid  action  in  the  blood-vessels 

,  remedies  for  the  inflammatory  state  of 

, ,  with  weak  morbid  action  in  the 

blood-vessels 

Dropsy  of  the  brain,  internal 
,  its  history 

,  its  causes 

,  its  cure  - 

Distress,  familiarity  with  it,  its  moral  effects 

Death,  its  proximate  cause 


• 

1. 

269 

i. 

446 

• 

1. 

338 

• 

i. 

374 

iv. 

163 

c 
iv. 

173 

iv. 

198 

iv. 

200 

L 

iv. 

202 

iv. 

210 

• 

i. 

186 

• 

i. 

ibid. 

• 

i. 

185 

•  • 

u. 

151 

•  • 

u. 

157 

•  • 

u. 

160 

•  * 

n. 

176 

•  • 

n. 

192 

•  • 

li. 

195 

•  » 

u. 

203 

•  • 

n. 

210 

•  ■ 

u. 

46 

•  * 

n. 

447 

INDEX. 

E. 

Emetics,  useful  in  the  bilious  fever  of  1780*         i.  186 

,  in  the  scarlatina  anginosaof  1783  and  1784  i.  144 

,  in  the  yellow  fever  of  1 798             -            iv.  79 

,  in  the  yellow  fever  of  1799                          iv.  97 

,  hurtful  in  the  yellow  fever  of  1 797             iv.  44 

Exhalations,  putrid,  their  sources  and  effects  in 

producing  the  summer  and  autumnal  disease  iv.  163 

R 

Faculty,  moral,  inquiry  into  the  influence  of  phy- 
sical causes  on                       -                                 ii.  3 
Fruits,  summer,  useful  in  destroying  worms         i.  229 
Fever,  bilious,  history  of  it  in  1780                         i.  117 
outlines  of  a  theory  of                       -          iii.  3 
its  unity  asserted              -              -               iii.  17 
unity  of  its  exciting  causes                           iii.  16 
objections  to  a  nosological  arrangement  of 
different  forms              -                  -                m.  33 
effects  of             -                     -                      iii-  39 
different  states  of,  enumerated                    iii.  41 
objections  to  putrefaction  in                         iii.  43 
bilious  yellow,  history  of,  in  1793               iii.  69 
its  exciting  causes                               iii.  88 
its  premonitory  signs                          iii.  93 
its  first  symptoms                                 iii.  95 
symptoms  of  it  in  the  blood-vessels  iii.  97 

,  in  the  liver,  lungs,  and  brain  iii.  104 

,  in  the  stomach  and  bowels     iii.  108 

,  in  the  secretions  and  excre- 


lts 


tions  -  -  iii.     HO 


INDEX. 

Fever,  bilious  yellow,  symptoms  of  it,  in  the 

nervous  system  -  iii.  116 

— — , , ,  in  the  senses  and  appetites     iii.  122 

, , ,  in  the  lymphatic  and  glandu- 
lar system  -  -  iii.  124 

, , ,  on  the  skin  iii.  125 

, , ,  in  the  blood  iii.  128 

— . — ,      ■     ,  nature  of  the  black  vomit  iii.  Ill 

j ,  types  of  the  -  iii.  135 

— ,  the  empire  of,  over  all  other  diseases  iii.  1 39 

— ,  who  most  subject  to  it  iii.  148 

— ,  negroes  affected  by  it  in  common 


■> 


with  white  people  -  iii.     151 

— , ,  state  of  the  atmosphere  during  the 


prevalence  of  -  iii.     158 

— , ,  signs  of  the  presence  of  miasmata  in 

the  body,  universal  -  iii.     157 

— , ,  cases  of  re  -infection  iii.     164 

— , ,  external  appearances  of  the  body  af- 
ter death  in  -  iii.     165 
— ,  appearances  of  the  body  by  dissec- 


tion  iii.     167 

— ,  account  of  the  distress  of  the  city    iii.     175 


-,  its  moral  effects  upon  the  inhabitants  iii.  1 79 

-,  number  of  deaths  from  it  iii.  181 

-,  is  checked  and  destroyed  by  rain     iii.  184 
-,  inquiry  into  its  origin  by  the  gover- 


nor  of  the  state  -  iii.     196 

— ,  i,  said  to  be  imported  by  the  college 


of  physicians  -  -  iii.     19 

— , ,  objections  to  their  opinion,  and  proofs 


of  its  domestic  origin  -  iii.     198 


INDEX. 

Fever,  bilious  yellow,  the  sameness  of  its  origin 

with  the  plague 
— — ,  state  of  the  weather  in  1793 
— ,  method  of  cure 

■  ,  dissentions  of  the  physicians 

,  of  purging, 

,  its  salutary  effects 

■  ■   ,  objections  to  it  answered 
,  blood-letting,  its  utility 


111. 

211 

•  •  • 

HI. 

215 

•  •  • 

111. 

223 

•  •  • 

111. 

235 

•  •  • 

111. 

239 

#  •  • 

111. 

241 

*•  • 

111. 

243 

•  •  • 

111. 

253 

•  •  • 

HI. 

284 

•  •  • 

111. 

269 

— — ,  salivation,  its  utility 
— ,  convalescence 

■  ■     ,  remarks  on  the  use  of  stimulating  reme- 
dies in  this  fever  -  -  iii.     292 

■  ■    ,  comparative  view  of  the  success  of  all  the 


modes  of  practice  employed  in  the  fever 
Fever,  yellow,  of  1 794,  history  of 
— — ,  its  exciting  causes 


-,  symptoms  in  the  different  systems  of  the 


body 

— ,  in  the  blood-vessels 

— ,  in  the  viscera 

,  in  the  alimentary  canal 

— ,  in  the  secretions  and  excretions 
— ,  in  the  nervous  system 
— ,  in  the  senses  and  appetites 

,  in  the  lymphatic  system 

— — ,  in  the  blood 

— ,  different  forms  of  the  fever 

— -,  its  origin 

,  method  of  cure 

— ,  bleeding 


111. 

298 

•  •  • 

111. 

357 

•  •  • 

HI. 

367 

•  •  • 

111. 

369 

•  •  • 

HI. 

ibid. 

•  •  • 

111. 

371 

•  •  • 

111. 

373 

•  •  • 

111. 

375 

*  •  • 

HI. 

379 

•  •  • 

111. 

383 

•  •  • 

111. 

ibid. 

•  •  ■ 

111. 

387 

•  •  • 

111. 

388 

•  •  • 

111. 

397 

•  •  • 

HI. 

401 

•  •  • 

111. 

402 

INDEX. 

Fever,  yellow,  of  1794,  good  effects  of  cool  air 

and  cold  water  in                     -  iii.  40f 

of  a  salivation                             -  iii.  411 

of  blisters             -  -             iii.  413 

of  tonic  remedies                 -  iii.  41 5 

of  the  inefficacy  of  bark  iii.  ibid. 

of  the  effects  of  wine                  -  iii.  418 

■■      of  opium                 -  iii.  419 

— —  of  nitre         -  -             iii.  421 

■      of  antimonials                 -  iii.  ibid. 

Fever,  yellow,  sporadic  cases  of,  in  the  years 

1795  and  1796                          -  iii.  437 

Fever,  yellow,  of  1797                     -  iv.  3 

■     ,  symptoms  of             -  -             iv.  13 

,  type  of                                    -  iv.  20 

,  different  forms  of                     -  iv.  21 
— ,  influence  of  the  moon  upon  it  iv.  27 
-,  number  of  deaths,  particularly  of  physi- 
cians                         -                     -  iv.  30 
— ,  origin  of  it                     -             -  iv.  33 
— -,  its  remedies                          -  iv.  ibid. 


— ,  of  bleeding             -                        -             iv.  ibid. 

— ,  of  purging  medicines                 -                  iv.  37 

— ,  of  a  salivation              -                     -             iv.  39 
— ,  different  ways  in  which  mercury  acted 

upon  the  mouth  and  throat              -                 iv.  40 

— ,  of  emetics             -                  -                     iv.  44 

— ,  of  diet  and  drinks  -              -             iv.  45 

— ,  of  tonic  remedies                     -                    iv.  49 

— ,  of  blisters              -  -               -             iv.  ibid. 

— — ,  of  sweet  oil                 -              -                   iv.  51 


INDEX. 

Fever,  yellow,  of  1797,  relative  success  of  differ- 
ent modes  of  practice  -  iv.       53 

,  signs  of  a  favourable  and  unfavourable  is- 
sue of  the  fever 

Fever,  yellow,  of  1798,  account  of 

,  symptoms  of 

,  in  the  blood-vessels 

,  alimentary  canal 

,  on  the  tongue 


-,  in  the  nervous  system 

-,  in  the  eyes,  lymphatics,  and  blood 

-,  different  modes  in  which  it  terminated  in 


death 

— ,  state  of  the  weather  in  1798 
— ,  origin  of  the  fever 
— ,  remedies  for  it 
— ,  bleeding 
emetics 


-,  purges^ 

-,  of  a  salivation 

-,  of  sweats 

-  of  bark 

-,  of  blisters 

-,  symptoms  which  indicated  a  favourable 


IV. 

55 

iv. 

67 

iv. 

68 

iv. 

ibid. 

iv. 

ibid. 

iv. 

69 

iv. 

ibid. 

iv. 

71 

l 
iv. 

74 

iv. 

77 

iv. 

78 

iv. 

ibid. 

iv. 

ibid. 

iv. 

79 

iv. 

81 

iv. 

ibid. 

iv. 

82 

iv. 

83 

iv. 

ibid. 

and  unfavourable  issue  of  the  disease  iv.       84 

— ,  different  modes  of  practice  in  this  fever, 


and  their  different  success                -  iv.  85 

Fever,  bilious,  of  1799               -               -  iv.  91 

,  sickliness  among  certain  animals  iv.  94 

,  its  symptoms              -                  -  iv.  95 

■ ,  its  remedies                       -               -  iv.  97 


INDEX. 


Fever,  yellow,  of  1799,  signs  of  a  favourable 

and  unfavourable  issue  of  it 
,  its  origin  -  - 


Fever,  yellow,  sporadic  cases  of,  in  1800 

, ,  in  1801 

Fever,  yellow,  of  1 802,  account  of 

■     ,  its  origin 
'     '     ,  its  types 

Fever,  yellow,  as  it  appeared  in  1803 
— ,  symptoms  of 

,  remedies  for 

Fever,  yellow,  sporadic  cases  in  1804 
Fever,  yellow,  as  it  appeared  in  1805 

,  its  origin 

,  its  remedies 


-,  not  contagious 


G, 


Gout,  peculiarities  belonging  to  it 

,  its  remote  causes 

,  women  most  subject  to  it 

,  its  exciting  causes 

,  its  symptoms 

,  method  of  cure 

-,  remedies  in  its  forming  state 


IV. 

99 

iv. 

100 

iv. 

103 

iv. 

111 

iv. 

123 

iv. 

123 

iv. 

127 

iv. 

133 

iv. 

136 

iv. 

139 

iv. 

147 

iv. 

153 

iv. 

155 

iv. 

156 

iv. 

223 

•  • 
n. 

227 

•  • 

u. 

230 

•  • 

ii. 

232 

•  * 

u. 

ibid. 

•  » 

n. 

234 

•  • 

n. 

251 

ii. 

253 

j  in  a  paroxysm,  when  attended  with  great 

morbid  or  inflammatory  action  in  the  blood- 
vessels -  -  -  ii.     252 

,  when  attended  with  weak  morbid  action 

in  the  blood-vessels  -  ii.     269 

,  remedies  for  its  symptoms  ii.     275 

vol.  iv.  3  G 


INDEX. 

Gout,  means  for  preventing  the  return  of  inflam- 
matory -  -  ii.     285 
with  weak  morbid  action                               ii.     293 

H. 

Hospitals,  their  origin 

-*- ,  military,  their  evils  * 

m ,  constructed  with  ground  floors,  to  be  pre- 
ferred in  fevers 

Heat,  greatest  in  Philadelphia 

Habit,  its  effects  upon  morals 

Haemoptysis,  observations  on 

Hydrophobia,  observations  on 

,  its  causes 

,  its  symptoms  in  rabid  animals 

?  — j  in  the  human  species 

,  supposed  to  be  a  malignant  fever 

,  remedies  to  prevent  it 

-4 ,  —  to  cure  it  in  its  malignant  or  inflam- 
matory state  -  -  ii.     317 

?  —  to  cure  it  when  attended  with  weak 

morbid  action  in  the  blood-vessels  ii.     323 

,  death  from  it,  supposed  to  be  from  suffo- 
cation -  -  ii.     326 

-a — -,  laryngotomy  suggested  to  prevent  it  ii.     332 


1. 

55 

i. 

276 

• 

l. 

275 

• 

l. 

87 

•  • 

n. 

43 

l. 

191 

•  • 

ii. 

301 

•  * 

u. 

302 

ii. 

306 

•  • 

ii. 

308 

•  • 

n. 

ibid. 

•  • 

u. 

315 

I. 

Indians,  oration  on  their  diseases  and  remedies 

,  peculiar  customs  of  their  women 

,  —  of  their  men  -         > 

-^ — -,  —  of  both  sexes 


3 

9 

11 

12 


INDEX. 

Indians,  their  diseases                 -             -              i.  16 

,  their  remedies                          -                       i.  20 

,  comparative  view  of  their  diseases  and 

remedies  with  those  of  civilized  nations  i.  39 
Iron,  its  preparations  useful  in  destroying  worms  i.  232 
Jaw-fall,  or  trismus,  in  infants  i.  254 
Imitation,  its  effects  upon  morals  ii.  ,  42 
Influenza,  account  of  it,  as  it  appeared  in  Phi- 
ladelphia in  1789,  1790,  and  1791  ii.  353 
— ,  history  of  its  symptoms  ii.  354 
,  mode  of  treatment                  -                       ii.  360 


L. 

Laudanum,  its  efficacy  in  the  disease  brought 
on  by  drinking  cold  water  in  hot  weather 

Legs,  sore,  observations  on 

,  classes  of  people  most  subject  to  them 

,  their  remedies 

Longevity,  circumstances  which  favour  it 

Life,  animal,  inquiry  into  its  causes 

,  a  forced  state,  or  the  effects  of  impres- 
sions - 

,  enumeration  of  those  impressions 


_ ?  how  supported  in  sleep 

,  in  the  foetus  in  utero 

,  in  infancy  -   ■      -    - 

,  in  youth 

,  in  middle  life 

,  in  old  age  -  -  ii.  ibid. 

,  in  persons  blind,  or  deaf  and  dumb  from 

their  birth  -  -  -  ii.     414 


1. 

185 

i. 

411 

i. 

412 

i. 

416 

i. 

428 

•  • 

ii. 

371 

•  • 

ii. 

377 

•  • 

n. 

378 

*  • 

ii. 

397 

ii. 

404 

•  • 

u. 

405 

•  ♦ 

n. 

409 

•  • 

u. 

410 

INDEX. 


Life,  in  idiots 

j  after  long  abstinence 

9  in  asphyxia 

,  in  the  Indians  of  North- America 
,  in  the  Africans 

,  in  the  Turkish  empire 

,  in  China  and  the  East- Indies 
— — ,  in  the  poor  inhabitants  of  Europe 
— ,  stimuli  which  act  alike  in  promoting  it  up- 
on all  nations 
— -— ,  how  supported  in  sundry  animals 
,  its  extinction  in  death,  how  effected 


*  » 

11. 

416 

ii. 

417 

•  • 

n. 

419 

•  • 

n. 

427 

u. 

428 

•  • 

ii. 

429 

•  • 

n. 

431 

•  • 

ii. 

432 

•  • 

u. 

434 

•  • 

441 

11. 

447 

M. 

Midwifery,  the  practice  of  it  more  successful  by 

men  than  by  women  -  i.       53 

Manufactures,  sedentary,  unfriendly  to  the  health 

of  men  -  -  i.       65 

Measles,  history  of,  in  1789  ii.     338 

,  their  symptoms  -  ii.     339 

,  a  spurious,  or  external  form  of  them  de- 
scribed -  -  ii.     342 
-,  remedies  used  in  them                                  ii.     346 

,  history  of  them,  as  they  appeared  in  1801  iv.     117 

Medicine,  an  inquiry  into  its  comparative  state, 
in  Philadelphia,  between  1760  and  1766,  and 
1805  -  -  iv.     365 

Diet  of  the  inhabitants  between  1 760  and 

1766  -  iv.     366 

Dresses  -  -  iv.     368 

Customs  which  had  an  influence  on  health  iv.     369 
Diseases  -  iv.     370 


INDEX. 

N. 

Nature,  meaning  of  the  term               -                 i.  35 

— ,  the  extent  of  her  powers  in  curing  diseases  i.  20 
Nosology,  objections  to  it  -  iii.  33 
Negroes  subject  to  the  yellow  fever  in  common 

with  the  white  people             -                 -         iii.  366 

O. 

Opium,  useful  in  the  bilious  fever  of  1780           i.  130 
— ,  the  disease  induced  by  it  cured  by  blood- 
letting                    -                     -                      iv.  357 
Onion  juice,  useful  in  destroying  worms              i.  231 

P. 

Philadelphia,  its  situation                 -                      i.  74 

— ,  population                          -                              i.  76 

,  diseases  between  1 760  and  1 766,  and  1 805  iv.  365 

Purges,  useful  in  the  bilious  fever  of  1780.           i.  127 

,  —  in  the  yellow  fever  of  1793                    iii.  231 

— ,  objections  to  them  answered                       iii.  243 

Pulse,  state  of,  in  old  people                                  i.  439 

,  in  the  yellow  fever  of  1793,  in  persons  not 

confined  with  it  -  iii.  157 
,  in  fevers,  when  it  indicates  blood-letting  iv.  316 
Putrefaction,  does  not  take  place  in  the  blood  iii.  43 
Pregnancy,  a  morbid  state  of  the  system  iv.  349 
,  effects  of  blood-letting  in  relieving  its  dis- 
eases -  -  iv.  ibid. 
Parturition,  a  disease                           -                 iv.  353 

,  effects  of  blood-letting  in  lessening   its 

pains                                                                     iv.  iblo- 


INDEX. 

Q. 

Quarantine  laws,  their  inefficacy  to  prevent  a  yd* 

low  fever  -  '  -  iv.     218 
,  their  evils                  -                       -  iv.  ibid. 

R. 

Rain,  usual  quantity  in  Pennsylvania  i.        72 

Revolution,  American,  its  influence  upon  the  hu- 
man body  and  mind  -  -  i.     279 


S. 

Snow,  common  depth  in  Pennsylvania 

Sweating  described  among  the  Indians  of  North- 
America  - 

Scarlatina  anginosa  of  1783  and  1784  described 

,  additional  observations  on 

,  prevented  by  gentle  purges 

,  cured  by  emetics  in  its  forming  state 

Salt,  common,  useful  in  the  haemoptysis 

,  in  destroying  worms 

Sugar,  useful  in  destroying  worms 

Spirits,  ardent,  their  effects  upon  the  human 
body  and  mind 

,  diseases  produced  by  them 

,  their  effects  on  property 

,  substitutes  for  them 

,  persons  predisposed  to  their  use 

,  their  influence  upon  the  population  of  the 

United  States 

Sweats,  useful  in  the  yellow  fever  of  1803  iv. 


91 

22 
138 
147 
151 
150 
192 
230 
ibid. 

337 
343 
347 
353 
360 

364 
140 


INDEX. 

Salivation,  its  usefulness  in  the  yellow  fever  of 

1793  -  -  -  iii.     284 

, ,  of  1794  -  iii.     411 

y ,  of  1797 

, ,  of  1798 

Small-pox,  new  mode  of  inoculating  for 

T. 

Tetanus,  its  causes 

— ,  its  remedies  when  from  wounds 

, ,  when  from  other  causes 

W. 

Winters,  cold,  in  Pennsylvania 

Winds,  common,  in  Pennsylvania 

Water,  cold,  disease  from  drinking  it  when  the 

body  is  preternaturally  heated  i.     184 

Worms,  natural  to  young  children,  and  to  young 

animals  -  -  i.     218 

,  intended,  probably,  to  prevent  disease         i.     21$ 

,  destroyed  by  medicines  that  act  mechani- 
cally and  chemically  upon  them  i.     128 

Wounds,  gun-shot,  in  joints,  followed  by  death    i.     274 


IV. 

49 

iv. 

81 

i. 

311 

• 

i. 

248 

i. 

256 

• 

l. 

259 

i.  76,  1 

77,  7& 

i. 

90 

FINIS. 


LATELY  PUBLISHED, 

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the  Means  of  Preserving  the  Health  of  Soldiers  in  Hot  Climates.  By  i?o- 
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IN    THE    PRESS, 


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